Intermittent Cyclophosphamide for the Treatment of Autoimmune Thrombocytopenia in Systemic Lupus Erythematosus
Authors: Dimitrios T. Boumpas
Journal: Annals of Internal Medicine (1990)

Articles1 May 1990Intermittent Cyclophosphamide for the Treatment of Autoimmune Thrombocytopenia in Systemic Lupus ErythematosusDimitrios T. Boumpas, MD, Shirin Barez, MD, John H. Klippel, MD, James E. Balow, MDDimitrios T. Boumpas, MD, Shirin Barez, MD, John H. Klippel, MD, James E. Balow, MDAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-112-9-674 SectionsAboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail ExcerptStudy Objective: To determine the effect of monthly intravenous cyclophosphamide therapy in patients with systemic lupus erythematosus and autoimmune thrombocytopenia.Design: Uncontrolled, retrospective clinical study.Setting: Government referral-based research hospital.Patients: Seven patients with systemic lupus erythematosus and 2 or more months of thrombocytopenia refractory to or requiring excessive doses of corticosteroids. Two patients had also failed to respond to splenectomy and repeated intravenous methylprednisolone infusions. Six patients had severe active renal disease at the time of treatment.Interventions: Cyclophosphamide, 0.75 to 1.0 g/m2 body surface area, was given intravenously every month for at least 4 months. Prednisone dose ranged between 0.5 to 1.0 mg/kg · d.Measurements and Main Results: All seven patients had normal platelet counts within 2 to 18 weeks after cyclophosphamide treatment (one to four doses). Prednisone was tapered to 0.25 mg/kg on alternate days in all patients. All six patients had significant improvement in their renal disease and lupus serologies. Cyclophosphamide was discontinued after four to six doses in five patients. Four patients maintained normal platelet counts on low dose, alternate-day prednisone for a mean of 5.6 years of follow-up. Two patients had recurrence of thrombocytopenia 1 to 3 years after discontinuing cyclophosphamide.Conclusions:Monthly intravenous cyclophosphamide is potentially useful for the management of autoimmune thrombocytopenia in patients with systemic lupus erythematosus who are refractory to or dependent on unacceptably high doses of corticosteroids, or are experiencing side effects of conventional medical or surgical treatment....References1. WallaceDubois DE, eds. Dubois' Lupus Erythematosus. 3d ed. Philadelphia: Lea & Febiger; 1987:438-9. Google Scholar2. HarveyShulmanTumulty ALP. Systemic lupus erythematosus: review of the literature and clinical analysis of 138 cases. Medicine (Baltimore). 1954;33:291-437. CrossrefMedlineGoogle Scholar3. BudmanSteinberg DA. Hematologic aspects of systemic lupus erythematosus. Current concepts. Ann Intern Med. 1977;86:220-9. LinkGoogle Scholar4. GernsheimerStrattonBallemSlichter TJPS. 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To continue reading please click on the PDF icon. Author, Article, and Disclosure InformationAuthors: Dimitrios T. Boumpas, MD; Shirin Barez, MD; John H. Klippel, MD; James E. Balow, MDFrom the National Institutes of Health, Bethesda, Maryland. For current author addresses, see end of text. 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