Successful treatment with vincristine of an infant with intractable Kasabach–Merritt syndrome

Vincristine-resistant Kasabach–Merritt phenomenon successfully treated with low-dose radiotherapy

“…To identify the most favorable combination of therapeutic reagents, stepwise multimodal approaches were recommended [6]. In addition to corticosteroid or IFNa-2 treatments, Haisley-Royster et al treated KMP patients with VCR, and confirmed the safety and effectiveness of VCR in 15 patients, and many studies have reported data demonstrating the effectiveness of VCR [1,3,4,7,8]. From these observations, we believe that a stepwise approach to KMP comprises either corticosteroids or INFa-2a for the first line, VCR for the second line, and irradiation is recommended if these treatments are not effective (third-line therapy).…”

“…1b, A, B). Since the maximum number of times VCR could be injected was 40 in cases of KMP or 31 in patients receiving VCR, actinomycin-D, and cyclophosphamide therapy for rhabdomyosarcoma, we concluded that VCR no longer exhibited any curative effects on KMP after 33 injections [4,5] (Fig. 1b, C).…”

“…Arterial embolization was considered but not attempted because the tumor was fed by several small feeding arteries, identified by MRI angiography. For these reasons, we gradually decreased the amount of PSL in conjunction with weekly VCR injection (0.8 mg/m 2 ) [2][3][4]. VCR enabled us to taper PSL; however, the effect on consumption coagulopathy was quite limited, and the constant injection of VCR (2-4 times/month) was necessary.…”

Hemangioma pada Anak

“…Mekanisme yang jelas tentang peran steroid belum diketahui secara pasti, walaupun ada dugaan bahwa steroid berpengaruh terhadap hemangioma dengan cara: 18,20 Beberapa penulis mengelompokkan steroid berdasarkan cara pemberian menjadi: 21,22 1. Kortikosteroid sistemik Pengobatan dengan kortikosteroid sistemik telah dianggap sebagai terapi medikamentosa yang paling efisien untuk cutaneous infantile hemangiomas tanpa komplikasi.…”

“…23 Ada laporang yang menyatakan bahwa vinkristin efektif digunakan pada kasus hemangioma yang mengancam jiwa yang resisten terhadap pengobatan steroid. Taki 20 dkk, menyatakan bahwa pada kasus intractable Kasabach-Merritt syndrome pemberian vinkristin sangat efektif, sehingga mereka menyarankan pemakaian vinkristin pada kasus demikian. Dosis yang dianjurkan 1.5 mg/m 2 per kali suntikan, jika diperlukan dapat diulang satu kali lagi dengan interval 2-3 bulan setelah suntikan pertama.…”