Comparison of cytokine responses with anti-d and intravenous immunoglobulin in idiopathic thrombocytopenia.

within 1–20 h after anti-D infusion [3], supporting the concept of cytokine immunomodulation with anti-D therapy. A recent paper by Del Vecchio et al. [4] showed that IL-10 levels at the onset may predict the course of patients with ITP, and higher levels have a positive outcome on disease remission within 1 year, while high thrombopoietin levels were not helpful in predicting the course of disease. This study however did not undertake serial monitoring of cytokine levels to assess whether a particular treatment and baseline high IL-10 contributed to the favorable outcome (i.e., remission within 1 year). In the era of monoclonal antibody therapy, and with advanced trials of symphoantibodies in ITP [5], cytokinebased studies in isolation will become increasingly difficult to interpret as these antibodies will interrupt various signaling pathways either directly or indirectly (downstream pathways). However, such preliminary studies are extremely important in advancing our knowledge and preventing untoward side effects in patients who enter into phase III clinical trials.