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Clinical and Developmental Immunology
Volume 2013 (2013), Article ID 548085, 9 pages
http://dx.doi.org/10.1155/2013/548085
Clinical Study

Effects of Rapamycin Combined with Low Dose Prednisone in Patients with Chronic Immune Thrombocytopenia

Key Lab of Thrombosis and Hemostasis of Ministry of Health, Jiangsu Institute of Hematology, The First Affiliated Hospital of Soochow University, 188 Shizi Street, Suzhou 215006, China

Received 22 September 2013; Accepted 5 November 2013

Academic Editor: Jacek Tabarkiewicz

Copyright © 2013 Jiaming Li et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

We conducted this randomized trial to investigate the efficacy and safety of rapamycin treatment in adults with chronic immune thrombocytopenia (ITP). Eighty-eight patients were separated into the control (cyclosporine A plus prednisone) and experimental (rapamycin plus prednisone) groups. The CD4+CD25+CD127low regulatory T (Treg) cells level, Foxp3 mRNA expression, and the relevant cytokines levels were measured before and after treatment. The overall response (OR) was similar in both groups (experimental group versus control group: 58% versus 62%, ). However, sustained response (SR) was more pronounced in the experimental group than in the control group (68% versus 39%, ). Both groups showed similar incidence of adverse events (7% versus 11%, ). As expected, the low pretreatment baseline level of Treg cells was seen in all patients ( ); however, the experimental group experienced a significant rise in Treg cell level, and there was a strong correlation between the levels of Treg cells and TGF-beta after the treatment. In addition, the upregulation maintained a stable level during the follow-up phase. Thus, rapamycin plus low dose prednisone could provide a new promising option for therapy of ITP.