Combination vincristine and plasma exchange as initial therapy in patients with thrombotic thrombocytopenic purpura: one institution's experience and review of the literature

Ziman, Alyssa; Mitri, Michael; Klapper, Ellen; Pepkowitz, Samuel H.; Goldfinger, Dennis

doi:10.1111/j.1537-2995.2005.03146.x

Cited by 64 publications

(52 citation statements)

References 76 publications

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“…In a literature review that involved 56 studies and 105 patients, stable remission was obtained in 73% of patients receiving vincristine as secondary or salvage therapy (ie, Ͼ3 days following diagnosis), with adverse events in only 5.7% of patients. 18 These studies were retrospective and uncontrolled, but provided the historical evidence that vincristine is an effective salvage therapy in patients with acquired TTP who do not respond optimally to standard treatment. Currently, vincristine is usually not prescribed because rituximab is considered a more attractive (and possibly more effective) strategy.…”

Section: Vincristine and Cyclosporine Amentioning

confidence: 99%

Treatment of thrombotic thrombocytopenic purpura beyond therapeutic plasma exchange

Coppo

Froissart

2015

Hematology

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Daily therapeutic plasma exchange (TPE) transformed the historically fatal prognosis of acquired, anti-ADAMTS13 antibody-mediated thrombotic thrombocytopenic purpura (TTP), leading to the current overall survival rates of 80%-85%. However, relapses occur in ϳ40% of patients and refractory disease with fatal outcomes still occurs. In this context, the introduction of rituximab has probably been the second major breakthrough in TTP management. Rituximab is now routinely recommended during the acute phase, typically in patients with a suboptimal response to treatment, or even as frontline therapy, with high response rates. In more severe patients, salvage strategies may include twice-daily TPE, pulses of cyclophosphamide, vincristine, as well as splenectomy in more desperate cases.In this life-threatening disease, relapse prevention represents a major goal. Persistent severe acquired ADAMTS13 deficiency in patients who are otherwise in remission is associated with a high risk of relapse and preemptive treatment with rituximab may be considered in this context.In the coming years, the TTP therapeutic landscape should be enriched by original strategies stemming from clinical experience and new agents that are currently being evaluated in large, ideally international, clinical trials. Promising agents under evaluation include N-acetylcysteine, bortezomib, recombinant ADAMTS13, and inhibitors of the glycoprotein-Ib/IX-von Willebrand factor axis. Learning Objectives• Patients with acquired TTP who experience a suboptimal response (refractoriness or disease exacerbation) with standard management need a more intensive treatment • Salvage therapies typically include rituximab, and in the more severe cases twice daily plasma exchange, boluses of cyclophosphamide, vincristine, and splenectomy • A persistent severe acquired ADAMTS13 deficiency during TTP remission should prompt consideration of preemptive rituximab to prevent relapses

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Section: Vincristine and Cyclosporine Amentioning

confidence: 99%

Treatment of thrombotic thrombocytopenic purpura beyond therapeutic plasma exchange

Coppo

Froissart

2015

Hematology

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“…VCR prevents the interaction between damaging immunoglobulin G antibodies and endothelial cells. Furthermore, VCR is known to alter PLT membrane glycoprotein receptors preventing their up regulation and binding of von Willebrand factor (VWF) multimers, thereby reducing PLT aggregation [36].…”

Section: Discussionmentioning

confidence: 99%

“…This report is also parallel with their valuable review of literature that demonstrated a significant advantage in durable remission rates in patients treated with combination TPE and VCR as initial therapy compared to patients treated with TPE without VCR. In a literature review that involved 56 studies and 105 patients, stable remission was obtained in 73% of patients receiving vincristine as secondary or salvage therapy (ie, >3 days following diagnosis), with adverse events in only 5.7% of patients (36). These studies were retrospective and uncontrolled, but provided the historical evidence that vincristine is an effective salvage therapy in patients with acquired TTP who do not respond optimally to standard treatment.…”

Section: Discussionmentioning

confidence: 99%

Thrombotic Thrombocytopenic Purpura Refractory to Plasmapheresis Treated Successfully with Vincristine: A Case Report

Elrewihby¹,

Zaghloul²,

Saber³

et al. 2017

J Blood Disord Transfus

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“…Durante los últimos años, varios trabajos prospectivos han tenido buenos resultados con su utilización, como terapia inicial y de rescate. En éstos se usó la plasmaféresis más un esquema de vincristina en una dosis inicial que variaba entre 1mg al día y 1,4 mg por m 2 , seguido por 3 dosis de 1 mg cada una día por medio 5,9,10,[14][15][16][17] . Diferente a nuestro caso, limitado por costos.…”

Section: Discussionunclassified

Púrpura trombocitopénico trombótico con respuesta exitosa a vincristina

Espinoza¹,

Leal²,

Arenas

2007

Rev. méd. Chile

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(Rev Méd Chile 2007; 135: 1572-6l púrpura trombocitopénico trombótico (PTT) forma parte del grupo de las microangiopatías trombóticas. En él se produce una agregación plaquetaria microvascular con formación de microtrombos plaquetarios sin fibrina. Se caracteriza por trombocitopenia, anemia hemolítica microangiopática, fiebre, compromiso neurológico y renal. Tiene una mortalidad cercana a 20%.Presentamos un caso de PTT, sin respuesta al tratamiento clásico, en el que se logra una rápida mejoría con vincristina. CASO CLÍNICOHombre de 24 años, previamente sano. Consultó por cuadro de 7 días de evolución de dolor cólico en fosa lumbar izquierda, asociado a hematuria moderada. Se diagnosticó un cólico renal, indicán-dose tratamiento ambulatorio. En los siguientes cuatro días tuvo una evolución tórpida, agregán-dose compromiso del estado general y disnea severa. Al examen físico se encontró febril, ictéri-co y con lesiones purpúricas en brazos.El cuadro clínico empeoró en las primeras horas de hospitalización, con generalización del púrpura y compromiso de conciencia que culminó en una convulsión tónico-clónica, sin focalización neurológica ni signos meníngeos. Se decidió ingreso a la

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Combination vincristine and plasma exchange as initial therapy in patients with thrombotic thrombocytopenic purpura: one institution's experience and review of the literature

Abstract: Our 100 percent survival rate, as well as evidence garnered from the literature review, suggests that combination therapy with VCR and TPE at presentation might be more effective than TPE alone and therefore warrants consideration as first-line therapy for TTP patients.

Cited by 64 publications

References 76 publications

Treatment of thrombotic thrombocytopenic purpura beyond therapeutic plasma exchange

Treatment of thrombotic thrombocytopenic purpura beyond therapeutic plasma exchange

Thrombotic Thrombocytopenic Purpura Refractory to Plasmapheresis Treated Successfully with Vincristine: A Case Report

Púrpura trombocitopénico trombótico con respuesta exitosa a vincristina

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