Can Immune Thrombocytopenia Be Cured with Medical Therapy?
Can Immune Thrombocytopenia Be Cured with Medical Therapy?
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DOI：
10.1055/s-0034-1544001
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发表时间：
2015-06-01
影响因子：
5.7
通讯作者：
Cines, Douglas B.
中科院分区：
文献类型：
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作者：
Cuker, Adam;Prak, Eline T. Luning;Cines, Douglas B.
成人原发性免疫性血小板减少症（ITP）通常呈慢性病程，需要持续监测和治疗。传统上，药物治疗被视为暂时提高血小板计数的一种手段，很少或没有可能诱导长期血小板反应。然而，最近的几项研究已经验证了这一假设，即在疾病过程的早期给予强化药物治疗可能会改善甚至治愈ITP。在这篇综述中，我们提出了一个生物学原理的医疗干预，同时针对先天性和适应性免疫反应管理的疾病过程中的早期。我们还严格审查了单药和多药药物治疗后的长期结局数据。针对炎症和适应性免疫的强化方案（例如，联合高剂量地塞米松和利妥昔单抗）与标准一线治疗（例如，泼尼松、单独高剂量地塞米松）。需要进行长期随访的对照试验，以确定这些强化治疗方案与标准治疗相比是否能诱导更多的治愈，或者只是以潜在的更大毒性为代价延迟复发。
Primary immune thrombocytopenia (ITP) in adults often assumes a chronic course that requires persistent monitoring and treatment. Medical therapy has traditionally been viewed as a means of temporarily raising the platelet count with little or no potential to induce long-term platelet responses off treatment. However, several recent studies have tested the hypothesis that intensive medical therapy administered early in the disease course may ameliorate or even cure ITP. In this review, we propose a biological rationale for medical intervention that simultaneously targets the innate and adaptive immune responses administered early in the course of disease. We also critically examine data on long-term outcomes after single-agent and multi-agent medical therapy. Intensive regimens that target inflammation and adaptive immunity (e.g., combination high-dose dexamethasone and rituximab) appear to improve response rates at 6 to 12 months compared with standard first-line therapy (e.g., prednisone, high-dose dexamethasone alone) in newly diagnosed patients. Controlled trials with extended follow-up are needed to determine whether these intensive regimens induce more cures compared with standard treatment or merely delay relapse at the expense of potentially greater toxicity.