Successful treatment of recurrent thrombotic thrombocytopenic purpura with plasmapheresis and vincristine

Abstract

An adolescent girl with severe thrombotic thrombocytopenic purpura (TTP) remained in a critical condition after 3 weeks of combined treatment with antiplatelet drugs, plasma infusions and plasma exchange. The introduction of vincristine resulted in gradual improvement and eventual complete remission which lasted for 2 years. When she relapsed, immediate improvement was observed with the combined treatment of plasmapheresis and vincristine. She has now been in complete remission again for 10 months. It is suggested that plasmapheresis plus vincristine should be used as the initial treatment for children with TTP.

Vincristine as salvage treatment for refractory thrombotic thrombocytopenic purpura

“…1 Kinetics of platelet count and serum LDH value in a responding patient several reports on the use of VCR for TTP have appeared in the literature. However, most of these described very small series or anecdotal patients; in addition, the schedule of VCR adopted in the different studies varied considerably [3,9,12]. The two largest series were published by Bobbio-Pallavicini et al in 1994 [1] and Mazzel et al in 1998 [4].…”

New strategies in diagnosis and treatment of thrombotic thrombocytopenic purpura: case report and review

“…In another case, oral cyclophosphamide resulted in a complete response in two patients with refractory TTP [16]. Van Gool et al [40] suggested the use of plasmapheresis plus vincristine in recurrent disease and for initial treatment. Despite these partially successful regimens a more rational approach and a better understanding of the pathogenesis was desirable.…”

A case of thrombotic thrombocytopenic purpura in an adult treated with vincristine

“…The resemblance of TTP to disorders in which vasculitis is prominent, e.g., systemic lupus erythematosus, prompted the use of cytotoxic agents such as vincristine sulfate in TTP patients. With vincristine, the results in TTP patients have been favorable in some case reports [13,23,25,27]. In other studies the benefit of vincristine was not confirmed [5] (see also Table 1).…”