Dapsone therapy for refractory immune thrombocytopenia patients: a case series

Ji Yun Lee; Jeong-Ok Lee; Joo Young Jung; Soo-Mee Bang

doi:10.5045/br.2017.52.2.95

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Original Article

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Blood Res 2017; 52(2):

Published online June 22, 2017

https://doi.org/10.5045/br.2017.52.2.95

Dapsone therapy for refractory immune thrombocytopenia patients: a case series

Ji Yun Lee¹, Jeong-Ok Lee¹, Joo Young Jung^2,#*, and Soo-Mee Bang^1,#

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¹Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea.

²Department of Internal Medicine, Dongtan Sacred Heart Hospital, Hallym University College of Medicine, Hwaseong, Korea.

Correspondence to : Soo-Mee Bang, M.D., Ph.D. Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, 82, Gumi-ro 173 beon-gil, Bundang-gu, Seongnam 13620, Korea. smbang7@snu.ac.kr

Received: December 10, 2016; Revised: March 1, 2017; Accepted: April 11, 2017

Abstract

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Abstract

Background

Dapsone has been recommended as a second-line immunosuppressive agent for patients with immune thrombocytopenia (ITP).

Methods

We retrospectively analyzed the efficacy and safety of dapsone therapy in patients with ITP.

Results

Nine ITP patients were treated with dapsone at a dose of 50?100 mg/day between May 2013 and March 2016. All patients were refractory to multiple previous treatments, with a median of 7 agents (range, 4?8), and 3 patients had undergone a previous splenectomy. The median pre-treatment platelet count was 4×10⁹/L (range, 3?27×10⁹/L). Only 1 patient (11.1%) responded to dapsone therapy. No severe adverse events were observed, except for 1 case of dapsone hypersensitivity syndrome.

Conclusion

Although dapsone is still useful for some patients, it may be ineffective in heavily pretreated patients with profound thrombocytopenia.

Keywords Immune thrombocytopenia, Dapsone, Efficacy, Toxicity

Article

Original Article

Blood Res 2017; 52(2): 95-99

Published online June 22, 2017 https://doi.org/10.5045/br.2017.52.2.95

Dapsone therapy for refractory immune thrombocytopenia patients: a case series

Ji Yun Lee¹, Jeong-Ok Lee¹, Joo Young Jung^2,#*, and Soo-Mee Bang^1,#

¹Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea.

²Department of Internal Medicine, Dongtan Sacred Heart Hospital, Hallym University College of Medicine, Hwaseong, Korea.

Correspondence to:Soo-Mee Bang, M.D., Ph.D. Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, 82, Gumi-ro 173 beon-gil, Bundang-gu, Seongnam 13620, Korea. smbang7@snu.ac.kr

Received: December 10, 2016; Revised: March 1, 2017; Accepted: April 11, 2017

Abstract

Background

Dapsone has been recommended as a second-line immunosuppressive agent for patients with immune thrombocytopenia (ITP).

Methods

We retrospectively analyzed the efficacy and safety of dapsone therapy in patients with ITP.

Results

Conclusion

Although dapsone is still useful for some patients, it may be ineffective in heavily pretreated patients with profound thrombocytopenia.

Keywords: Immune thrombocytopenia, Dapsone, Efficacy, Toxicity

Abstract

Fig 1.

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Figure 1.

Platelet count during dapsone treatment of (A) patient 2 and (B) patient 3.

Blood Research 2017; 52: 95-99https://doi.org/10.5045/br.2017.52.2.95

Fig 2.

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Figure 2.

Clinical feature of a patient with dapsone hypersensitivity syndrome. (A) Skin erythema with extensive scaling on face and neck. (B) Multiple hypermetabolic lymph nodes in both neck and axilla, portocaval, celiac axis, retrocrural, both paraaortic, aortocaval, and both external iliac and inguinal areas.

Blood Research 2017; 52: 95-99https://doi.org/10.5045/br.2017.52.2.95

Table 1 . Patient data and results of dapsone treatment for immune thrombocytopenia..

^a)Patient remained on dapsone for 39.3 months. ^b)Response defined as platelet count ≥30×10⁹/L and at least 2-fold increase over the baseline count and absence of bleeding..

Abbreviations: F, female; M, male; TPO-RA,thrombopoietin-receptor agonist..

Table 2 . A summary of studies on dapsone therapy in patients with ITP..

^a)Forty patients were found to have primary ITP. ^b)Sixteen patients were found to have primary ITP. ^c)Response to dapsone was defined as a platelet count >50×10⁹/L..

Abbreviations: CR, complete response (>10×10⁹/L); ITP, immune thrombocytopenia; NR, no response (<5×10⁹/L); PR, partial response (5–10×10⁹/L); R, response (>5×10⁹/L)..