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Dapsone: An Old but Effective Therapy in Pediatric Refractory Immune Thrombocytopenia

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Abstract

There are no definitive guidelines for management of chronic or refractory immune thrombocytopenia (ITP) in children. Dapsone is an inexpensive and efficacious, yet neglected, therapeutic option for treatment of chronic ITP. We evaluated the efficacy and safety of dapsone in the management of chronic ITP in children. Children with chronic ITP < 14 years with minimum grade 2 bleeds refractory to either splenectomy/rituximab/eltrombopag; who were offered dapsone therapy were retrospectively analyzed. Dapsone intolerance and G6PD deficiency were excluded. Dapsone was started at a dose of 1–2 mg/kg/day. Response to dapsone as per international working group definitions, time to response along with side-effects were noted. Forty-four children enrolled; 29 analyzed. Nineteen were refractory to rituximab, 8 to splenectomy and 6 to eltrombopag. Median age was 9.8 years (3–14) with 16/29 males. Median dapsone dose was 1.59 mg/kg/day (range 1–2.1). Overall response was seen in 21/29 (72%): Complete Response in 7/29 (24%), Partial Response in 14/29 (48%). All responses were sustained for minimum 3 months. Median duration to response was 2.9 months (2–6.6). Median follow up was 28 months (6–73) and relapse rate-21%. Major side effects noted: Methemoglobinemia-01, skin ulceration-02. In three cases dapsone could be tapered and stopped without relapse. Dapsone is an economical and efficacious agent with good safety profile in childhood chronic/refractory ITP.

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Abbreviations

ITP:

Immune thrombocytopenic purpura

TPO-R:

Thrombopoeitin receptor

G6PD:

Glucose 6 phosphate dehydrogenase

CR:

Complete response

PR:

Partial response

NR:

No response

IWG:

International working group

CTCAE:

Common terminology criteria for adverse events

HRQoL:

Health related quality of life

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Authors and Affiliations

  1. Department of Pediatrics, Army Hospital Research and Referral, Delhi, 110010, India

    Sanjeev Khera

  2. Department of Hematology, Army Hospital Research and Referral, Delhi, India

    Suman Kumar Pramanik, Uday Yanamandra & Kundan Mishra

  3. Department of Hematology, Command Hospital EC, Kolkata, India

    Rajan Kapoor

  4. Department of Hematology, Command Hospital SC, Pune, India

    Satyaranjan Das

Authors
  1. Sanjeev Khera
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  2. Suman Kumar Pramanik
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  3. Uday Yanamandra
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  4. Kundan Mishra
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  5. Rajan Kapoor
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  6. Satyaranjan Das
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Contributions

All authors contributed to the study conception and design. Material preparation, data collection and analysis were performed by SK. The first draft of the manuscript was written by SK and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

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Correspondence to Sanjeev Khera.

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All authors declare that they have no conflict of interest.

Ethical Approval

 Being a retrospective observational study for an established drug use in a particular condition the ethics committee approval was not warranted.

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Informed consent was obtained from parents/guardians of all individual participants included in the study at the time of enrollment.

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Khera, S., Pramanik, S.K., Yanamandra, U. et al. Dapsone: An Old but Effective Therapy in Pediatric Refractory Immune Thrombocytopenia. Indian J Hematol Blood Transfus 36, 690–694 (2020). https://doi.org/10.1007/s12288-020-01286-9

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  • DOI: https://doi.org/10.1007/s12288-020-01286-9

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