Cyclosporin A for persistent or chronic immune thrombocytopenia in children

Twenty percent of children with immune thrombocytopenia (ITP) develop a chronic course where treatment strategy is less established. Cyclosporin A (CSA) has been shown to be effective in small series of children with chronic ITP and might reduce the need for chronic steroid therapy and/or splenectomy. We reviewed consecutive patients below 18 years old with persistent or chronic ITP treated with CSA in our unit between January 1998 and June 2015. Thirty patients (14 boys and 16 girls) were included. The median age at initial diagnosis of ITP was 5 years (range 0.5–16.2 years). CSA was started at a median of 13.9 months (range 3.4–124 months) after initial diagnosis and given for a median duration of 9.3 months (range 0.2–63.9 months). The median platelet count before commencement was 12 × 10⁹/L (range 4–199 × 10⁹/L). The median dose of CSA was 6 mg/kg/day (range 2.4–7.5 mg/kg/day). Complete response (CR) or response (R) was achieved in 17 patients (57 %), and 7 (23 %) had sustained response. Side effects (most commonly hirsutism) were tolerable and reversible. CSA appeared effective in about half of persistent or chronic ITP patients and safe as a second-line agent in managing these children.