Slow Infusion of Vincristine in the Treatment of Refractory Thrombocytopenic Purpura

Linares, Mariano; Cerveró, Alba Jover; Sanchez, M; García, Sofía; Miguel-Sosa, A; Miguel-García, A; Miguel-Borja, Jose M.

doi:10.1159/000205627

Cited by 18 publications

(7 citation statements)

References 4 publications

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“…Our results suggest the short-term efficacy of VCR (86% after a median of 7 d), particularly in ND and P ITP (87.5%). These results match those in the literature, where a short-term response was found in 50-90% of cases (12)(13)(14)(15)(16)(17). We also found a median length of time without failure or relapse of 15 months.…”

Section: Discussionsupporting

confidence: 92%

“…Therefore, we cannot identify a combination of treatments that would be more likely to lead to a better response to VCR. The median time for an initial response was 7 d [IQR [6][7][8][9][10][11][12][13]. Therefore, VCR cannot be considered a therapeutic failure until 2 months after the first dose.…”

Section: Discussionmentioning

confidence: 99%

“…In C ITP, VCR was effective (>50 × 10 9 platelets/L) after 21 d in 58–75% of the reported patients , but when analysed in series by Facon et al . , seven of the nine responders relapsed within 8 wk.…”

mentioning

confidence: 94%

“…In C ITP, VCR was effective (>50 9 10 9 platelets/L) after 21 d in 58-75% of the reported patients (12)(13)(14)(18)(19)(20), but when analysed in series by Facon et al (14), seven of the nine responders relapsed within 8 wk. Side effects of vinca alkaloids in ITP are generally moderate and can include mild, reversible peripheral neuropathy (14,16,19) and, rarely, neutropenia (14).…”

mentioning

confidence: 95%

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Vincristine efficacy and safety in treating immune thrombocytopenia: a retrospective study of 35 patients

Stirnemann

Kaddouri

Khellaf

et al. 2015

European J of Haematology

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Although vincristine (VCR) is sometimes prescribed for newly diagnosed immune thrombocytopenia (ITP), its efficacy in refractory ITP and sustained efficacy has yet to be demonstrated. We describe our clinical experience and recommend vincristine's correct place in ITP management. This retrospective study analysed data from 35 patients with newly diagnosed (ND), persistent (P) or chronic (C) ITP treated with VCR. The initial response rate, defined as >30 × 10(9) platelets/L, reached 86% after a median of 7 [interquartile range (IQR) 6-13] days. In ND and P ITP, even when previous therapies were inefficient, initial response was 87.5%, suggesting that this treatment could be used particularly in rescue. Median survival time, without failure or relapse, was 15 months (Kaplan-Meier curve). Predictive factors (univariate analysis) of an initial and long-term response were a small number of prior treatments received. However, at 2 yr, only seven patients had sustained response. Eight (23%) patients experienced adverse events: neuropathy for seven and bowel obstruction for one. Vincristine efficacy in ITP was confirmed, and it could be a good strategy for treating resistant ITP, especially in emergencies. In this era of new therapeutics, VCR deserves to remain on the list of ITP treatments because of its initial efficacy, safety and low cost.

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Section: Discussionsupporting

confidence: 92%

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 94%

mentioning

confidence: 95%

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Vincristine efficacy and safety in treating immune thrombocytopenia: a retrospective study of 35 patients

Stirnemann

Kaddouri

Khellaf

et al. 2015

European J of Haematology

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“…VincristinwirdmiteinerDosisvon1-2mg1×proWochefür 4-6Wochenverabreicht,Vinblastinmit5-10mg.HäufigeNe-benwirkungensinddiezytostatikainduzierteThrombozytopenie,Neuropathie,Obstipation.DieWirkunghältinderRegel nichtlangean [143][144][145][146].…”

Section: Vincristin/vinblastinunclassified

Diagnostik und Therapie der Immunthrombozytopenie

Matzdorff¹

2019

Info Onkol.

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Bisher ging man davon aus, dass bei der ITP sowohl der ThrombozytenabbaualsauchdieNeubildungvonThrombozytenerhöhtsind.EinTeilderPatientenhatjedochzusätzlich zum vermehrten Thrombozytenabbau eine insuffiziente Thrombozytopoese[26-28].MöglicherweisestörendieAnti-körpergegenThrombozyten-GlykoproteineauchdieReifung derMegakaryozytenimKnochenmark[29-33]. Darüber hinaus gibt es noch mindestens einen weiteren Mechanismus. Bei ITP-Patienten sind die Thrombopoietinspiegel im Vergleich zu gesunden Menschen zwar erhöht, aberdennochdeutlichniedrigeralsbeianderenErkrankungen, die einen vergleichbaren Thrombozytenmangel aufweisen (z.B. aplastische Anämie oder auch nach Chemotherapie).MansprichtdeshalbvoneinemrelativenThrombopoietinmangel [34, 35]. Die Ursache für den relativen Thrombopoietinmangel liegt nach derzeitiger Vorstellung in einem gesteigerten Abbau von Thrombopoietin. Thrombopoietin wird physiologischerweise an Thrombozyten gebunden und zusammenmitdiesenThrombozyteninderMilzphagozytiert undzerstört[35].DieshatzurEntwicklungderTRAsundzu neuenTherapiekonzeptengeführt.

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Idiopathic Thrombocytopenic Purpura

Imbach¹

2006

Pediatric Hematology

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Slow Infusion of Vincristine in the Treatment of Refractory Thrombocytopenic Purpura

Cited by 18 publications

References 4 publications

Vincristine efficacy and safety in treating immune thrombocytopenia: a retrospective study of 35 patients

Vincristine efficacy and safety in treating immune thrombocytopenia: a retrospective study of 35 patients

Diagnostik und Therapie der Immunthrombozytopenie

Idiopathic Thrombocytopenic Purpura

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