TO THE EDITOR:
McMillan [1] thoroughly reviewed therapeutic alternatives for patients with refractory chronic immune thrombocytopenic purpura. Another clinical concept, based on animal models and circumstantial clinical evidence, is emerging. Increasing safety and cost-effectiveness of hematopoietic stem-cell transplantation in the area of malignant diseases extended the availability of such procedures to patients with severe autoimmune disorders, including immune thrombocytopenic purpura [2, 3]. Remissions in patients with this latter condition in whom multiple therapies had previously failed and who were treated with autologous or allogeneic stem-cell transplantation have already been reported [4, 5]. The hope is that more intensive immuno-suppression, in combination with the reconstitution of a new immune system, may provide long-lasting therapeutic benefit. This approach is currently being tested clinically.
1. McMillan R. Therapy for adults with refractory chronic immune thrombocytopenic purpura. Ann Intern Med. 1997; 126:307-14.
2. Bennett C, Armitage J, Armitage G, Vose JM, Bierman PJ, Armitage JO, et al. Costs of care and outcomes for high-dose therapy and autologous transplantation for lymphoid malignancies: results from the University of Nebraska 1987 through 1991. J Clin Oncol. 1995; 13:969-73.
3. Marmont A, Tyndall A, Gratwohl A, Vischer T. Hematopoietic precursor-cell transplants for autoimmune diseases. Lancet. 1995; 345:978.
4. Lim SH, Kell J, Al-Sabah A, Mumar-Bashi W, Bailey-Wood R. Peripheral blood stem cell transplantation for severe refractory autoimmune thrombocytopenic purpura [Abstract]. Blood. 1996; 88(Suppl 1):133a.
5. Raetz E, Beatty PG. Cord blood transplantation for refractory Evans syndrome [Abstract]. First International Meeting on Hematopoietic Stem Cell Therapy in Autoimmune Diseases. Basel, Switzerland. September 1996:18.
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