Vinblastine in the treatment of children and adolescents with refractory immune thrombocytopenia

Fresneau, Brice; Petit, Arnaud; Courcoux, Mary-France; Tabone, Marie‐Dominique; Auvrignon, Anne; Landman‐Parker, Judith; Leverger, Guy

doi:10.1002/ajh.22081

Cited by 10 publications

(6 citation statements)

References 31 publications

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“…Reported response at 1 month is highly variable but can be as low as 18%; durable response ranges from 0% to 42%. 164,[188][189][190][191][192][193][194][195][196][197][198] Unfortunately, these drugs are accompanied by significant toxicity. Almost all patients experience side effects, with vincristine neuropathy (27.8%), vinblastine-associated bone marrow suppression, constipation (3.5%), hyponatremia, and infusion site vesication (10.5%) being most common; these effects worsen with repeated dosing.…”

Section: Good Practice Statementmentioning

confidence: 99%

American Society of Hematology 2019 guidelines for immune thrombocytopenia

et al. 2019

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Background: Despite an increase in the number of therapies available to treat patients with immune thrombocytopenia (ITP), there are minimal data from randomized trials to assist physicians with the management of patients. Objective: These evidence-based guidelines of the American Society of Hematology (ASH) are intended to support patients, clinicians, and other health care professionals in their decisions about the management of ITP. Methods: In 2015, ASH formed a multidisciplinary guideline panel that included 8 adult clinical experts, 5 pediatric clinical experts, 2 methodologists with expertise in ITP, and 2 patient representatives. The panel was balanced to minimize potential bias from conflicts of interest. The panel reviewed the ASH 2011 guideline recommendations and prioritized questions. The panel used the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach, including evidence-to-decision frameworks, to appraise evidence (up to May 2017) and formulate recommendations. Results: The panel agreed on 21 recommendations covering management of ITP in adults and children with newly diagnosed, persistent, and chronic disease refractory to first-line therapy who have non–life-threatening bleeding. Management approaches included: observation, corticosteroids, IV immunoglobulin, anti-D immunoglobulin, rituximab, splenectomy, and thrombopoietin receptor agonists. Conclusions: There was a lack of evidence to support strong recommendations for various management approaches. In general, strategies that avoided medication side effects were favored. A large focus was placed on shared decision-making, especially with regard to second-line therapy. Future research should apply standard corticosteroid-dosing regimens, report patient-reported outcomes, and include cost-analysis evaluations.

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Section: Good Practice Statementmentioning

confidence: 99%

American Society of Hematology 2019 guidelines for immune thrombocytopenia

et al. 2019

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“…Weekly IV doses of vincristine (1-2 mg for 2-4 weeks) or vinblastine (10 mg for 1-3 weeks) are associated with rapid responses of 71% at 7 days and 68% at 1 month in patients with ITP. [99][100][101][102][103][104][105][106][107][108][109][110] Unfortunately, these high rates of response are accompanied by a low rate of durable response (28%) and significant toxicity. However, when combined with other agents, vinca alkaloids may be useful in patients requiring emergency treatment (evidence level IIb).…”

Section: Goals Of Therapymentioning

confidence: 99%

Updated international consensus report on the investigation and management of primary immune thrombocytopenia

et al. 2019

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Over the last decade, there have been numerous developments and changes in treatment practices for the management of patients with immune thrombocytopenia (ITP). This article is an update of the International Consensus Report published in 2010. A critical review was performed to identify all relevant articles published between 2009 and 2018. An expert panel screened, reviewed, and graded the studies and formulated the updated consensus recommendations based on the new data. The final document provides consensus recommendations on the diagnosis and management of ITP in adults, during pregnancy, and in children, as well as quality-of-life considerations.

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“…Almost all patients experience adverse events, such as vincristine neuropathy, vinblastine-associated bone marrow suppression, constipation, hyponatremia, and infusion site vesication. Vinca alkaloids are contraindicated in pregnancy and lactation [ 93 - 95 ].…”

Section: Recommendationsmentioning

confidence: 99%

Management of immune thrombocytopenia: 2022 update of Korean experts recommendations

Park

Kim

et al. 2022

Blood Res

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Despite the availability of therapies to treat patients with immune thrombocytopenia (ITP), there is currently little data from randomized trials to assist clinicians in managing patients. The evidence-based guidelines of the Korean Society of Hematology Aplastic Anemia Working Party (KSHAAWP) are intended to support patients and physicians in the management of ITP. Experts from the KSHAAWP discussed and described this guideline according to the current treatment situation for ITP in Korea and finalized the guidelines. The expert panel recommended the management of ITP in adult and pediatric patients with newly diagnosed, persistent, and chronic disease refractory to first-line therapy with minor bleeding. Management approaches include observation and administration of corticosteroids, intravenous immunoglobulin, anti-D immunoglobulin, and thrombopoietin receptor agonists. Currently, evidence supporting strong recommendations for various management approaches is lacking. Therefore, a large focus was placed on shared decision-making, especially regarding second-line treatment.

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Vinblastine in the treatment of children and adolescents with refractory immune thrombocytopenia

Cited by 10 publications

References 31 publications

American Society of Hematology 2019 guidelines for immune thrombocytopenia

American Society of Hematology 2019 guidelines for immune thrombocytopenia

Updated international consensus report on the investigation and management of primary immune thrombocytopenia

Management of immune thrombocytopenia: 2022 update of Korean experts recommendations

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