Pediatric Hematology and Oncology, 17:725± 726, 2000Copyright C° 2000 Taylor & Francis0888-0018/00 $12.00 + .00

Letter to the Editor

MEGADOSE METHYLPREDNISOLONE FOR EVANS SYNDROME

Sinasi Ozsoylu, MD h Department of Pediatrics and Hematology, FatihUniversity and Faculty of Medicine, Ankara, Turkey

I have read Dr. Ertem et al.’s interesting case report related to Hodgkindisease, which was presented as Evans syndrome [1] initially. For the treat-ment of Evans syndrome the authors used short-term megadose methylpred-nisolone (MDMP; daily 30 mg/kg for 3 days and 20 mg/kg for 4 days), whichwas suggested for the treatment of acute idiopathic thrombocytopenic pur-pura by us [2]. Although the authors observed some improvement with thisdose, complete cure was observed in my 4 patients with Evans syndromeby using long-term MDMP [3] (daily, 30 mg/kg for 3 days, then 20 mg/kgfor 4 days subsequently 10, 5, 2, and 1 mg/kg for 1 week each, each dosegiven before 8 AM at once, originally intravenously, orally recently) as wasused for the treatment of acquired aplastic anemia [4], Diamond± Blackfansyndrome [5], idiopathic myelo® brosis [6], acute leukemias [7], etc. [3].

I am insistant about the dose and the time of MDMP administrationfor obtaining full response and less toxicity (almost none) of corticosteroid,which is supported by others [8].

REFERENCES

1. Ertem M, Uysal Z, Yavuz G, G ÈozdaËsoÆglu S. Immune thrombocytopenia and hemolytic anemia as apresenting manifestation of Hodgkin disease. Pediatr Hematol Oncol. 2000;17:181 ± 185.

2. ÈOzsoylu SË , Ert Èurk G. Oral versus intravenous megadose of methylprednisolone for childhood idio-pathic thrombocytopenic purpura. Blood. 1991;77:1856.

3. ÈOzsoylu SË . High dose intravenous methyprednisolone (HIVMP) in hematologic disorders. HematolRev. 1990;4:197± 207.

4. ÈOzsoylu SË . CoËskun T, Minassazi S. High dose intravenous glucorticoid in the treatment of childhoodacquired aplastic anemia. Scand J Hematol. 1984;33:309 ± 316.

5. ÈOzsoylu SË . High dose intravenous corticosteroid for a patient with Diamond± Blackfan syndrome re-fractory to classical prednisone treatment. Acta Haematol. 1984;71:207 ± 210.

6. ÈOzsoylu SË , Ruacan SË . High dose intravenous corticosteroid treatment in childhood idiopathic myelo® -brosis. Acta Haematol. 1986;75:49± 51.

Received 25 April 2000; accepted 25 April 2000.Address correspondence to SË inasi ÈOzsoylu, MD, Professor of Pediatrics and Hematology, Fatih

University Faculty of Medicine, Alparslan T ÈurkeËs cad. No:57, 06510 Emek-Ankara, Turkey.

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7. Hi Ëcs Èonmez G, ÈOzsoylu SË , G Èurgey A, Zamani VP, ÇIrken G. High dose methylprednisolone for remis-sion induction in children with acute non-lymphoblastic leukemia. Eur J Haematol. 1989;42:498± 501.

8. Bernini JC, Carrillo JM, Buchanan GR. High-dose intravenous methylprednisone therapy for patientswith Diamond± Blackfan anemia refractory to conventional doses of prednisone. J Pediatr. 1995;127:654± 659.

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