| [Background]Primary immune thrombocytopenia (ITP) is an immune-mediated disease characterized by decreased platelet (PLT) counts. Present available treatment modalities have shown insufficient benefits to a number of ITP patients in controlling their PLT counts efficaciously. The decrease of PLT counts makes these patients suffering from a high risk of bleeding though under persistent drug therapy. The long-lasting treatment by drugs and transfusions leads great burden of economy and poor quality of life to these ITP patients. Furthermore, beside the positive effects, drugs such as corticosteroids and immunosuppressors may cause serious treatment-related adverse events when used chronically. Recent reports have provided evidence that the aberrant DNA methylation indeed presented in the etiology of ITP. Decitabine (DAC), a DNA-hypomethylating agent, which has been widely used in the management of myelodysplastic syndrome (MDS) was manifested a clinically significant increase in PLT count during the treatment. DAC demonstrate the effect of demethylate without cytotoxicity at low doses, which ensure the safety of patients under this treatment. Moreover, recent studies confirmed that low-dose DAC enhanced PLT release and megakaryocyte maturation in vitro. All these abov laid a reliable basis to the usage of low-dose DAC in the treatment of ITP.[Objective]Evaluate the effect of low-dose decitabine in the treatment to primary immune thrombocytopenia.[Method]Adopt three cases referred to our institution during September 2015 to October 2015 who meet the diagnosis standards of ITP. These patients had suffered from decreased PLT counts below 20 X 109/L and haemorrhagic signs such as ecchymosis, epistaxis and oral mucosal errhysis though first- and second-line therapies were given. We offered them the treatment with low-dose DAC (3.5mg/m2 daily for 3 days every 4-6 weeks). The effect of this therapy is assessed by the variations in PLT counts and bleeding events pro- and post-treatment.[Result]The first case is a 71-year-old man whose PLT count used to be 2× 109/L with epistaxis, gingival haemorrhage and ecchymoses on his lower limbs pro-treatment with low-dose DAC. After the usage of the 3 days therapy, his PLT count increased to 29 × 109/L with a remission of haemorrhagic signs. The second treatment used in the fifth week gave him a rise in PLT count from 24 × 109/L to 28 ×109/L. At the tenth week, he was readmitted to our hospital with a PLT count of 45 ×109/L to accept his third cycle of this regimen and gained an increase in PLT count to 60 ×109/L. His PLT count reached the number of 88 × 109/L and no bleeding events appeared since his first therapy.The second case is a 25-year-old woman with oral mucosal errhysis and ecchymoses on her lower limbs pro-treatment. Her PLT count rebound rapidly from 16×109/L to 78×109/L, which relieved her signs in bleeding. However, her PLT count began to decrease gradually to 3 × 109/L since the second week till the fifth week. She returned to our institution with epistaxis and ecchymoses on her lower limbs for the second cycle of the therapy. The therapy improved her PLT count to 15 ×109/L and restrained her haemorrhagic signs up till now.The third case is a 25-year-old man who suffered from decreased PLT count of 7 × 109/L with epistaxis, oral mucosal errhysis and petechiae spread all over his trunk and limbs. This regimen increased his PLT count to 27×10/L and terminated his bleeding events.None of the detrimental effects produced by DAC occurred to these patients throughout their treatment above.[Conclusion]Low-dose decitabine has the effect in the management of platelet count and haemorrhage to patients with primary immune thrombocytopenia. |
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