Long-term outcomes of combined chemotherapy in chronic refractory idiopathic thrombocytopenic purpura

In summary, approximately 67.9% of refractory ITP patients with low-dose combination chemotherapy eventually achieved a remission (CR or PR) in our study. Thus combination chemotherapy may be an effective treatment for some chronic refractory ITP patients. However, the optimal drug and the timing of the combination chemotherapy require further study. Our study would provide some valuable information for future studies. However, it did not compare with other treatments (or no treatment) in controlled trials. Thus, further research, including well designed prospective cohort studies of consecutive patients and randomized, controlled clinical trials evaluating the clinical symptoms and platelet count response, is needed to find the most optimal treatment with greater benefit/risk ratio for refractory patients to improve the response rate of refractory ITP, reducing clinically important bleeding or mortality.