Vincristine for Successful Treatment of Steroid-Dependent Infantile Hemangiomas

Abstract

Infantile hemangiomas (IHs) are common, although systemic therapy has been generally limited to circumstances of potential compromise of vital functions (airway, vision, feeding, or cardiac), risk of disfigurement, or bleeding. IHs have previously been shown to express high levels of type III deiodinase, which catabolizes active thyroid hormone, resulting in a state of severe hypothyroidism, termed “consumptive hypothyroidism.” We describe an infant with diffuse hepatic hemangiomas who developed consumptive hypothyroidism who was initially treated successfully with systemic glucocorticoids and β-blockers. Several efforts to wean her medications were unsuccessful. She subsequently developed severe growth restriction and treatment alternatives were sought. Although previously limited to treatment of life-threatening hemangiomas, a trial of vincristine was initiated. She was ultimately weaned from all systemic therapies, with recovery of a normal growth trajectory. This case highlights broader indications for vincristine as a safe and effective systemic therapy for treatment of IHs. It also stresses the importance of close anthropometric monitoring of infants and toddlers receiving glucocorticoid therapy and intervention when growth compromise becomes evident.

Retracted: Propranolol suppresses HUVEC viability, migration, VEGF expression, and promotes apoptosis by downregulation of miR‐4295

“…2 Though nearly 80% of hemangiomas are located in the head and neck region without treating, about 20% of the cases are complex with a series of complications, including deformity, bleeding, visual impairment, respiratory congestion, congestive heart failure, and even death. [5][6][7][8] Since oral propranolol is first reported to treat IH in 2008, 5 a large number of clinical studies (case reports and case series reports) have evaluated its efficacy and safety. The choice of this disease treatment is mainly based on expert opinion and observational study.…”

Vascular anomaly cases for the pediatric hematologist oncologists—An interdisciplinary review

“…These multifocal lesions usually only require medical therapy if clinically significant (e.g., heart failure, shunting) and/or are associated with cutaneous lesions causing disfigurement or interference with vital structures . Propranolol is the first‐line medical treatment for hemangiomas; steroids and vincristine (VCR) have been used in the past . Resection is virtually never indicated.…”

Comparison of Efficacy and Safety Between Propranolol and Steroid for Infantile Hemangioma

“…7 A type of anticancer drug or immunomodulator, interferon alfa, may be used for severe IH in cases where patients did not respond to steroids. 8,9 However, interferon alfa also has several possible adverse effects, including fever, muscle pain, systemic myalgia, and in severe cases, liver damage, blood toxic effects, thyroid hormonal abnormality, and neurological and neurodevelopmental toxic effects. 8 Because of concerns about these adverse effects, many guardians of pediatric patients prefer to wait rather than accept treatment.…”