Vincristine therapy for severe and refractory immune thrombocytopenia following COVID-19 vaccination

Saito, Kei; Ichikawa, Satoshi; Hatta, Shunsuke; Katsuoka, Yoji; Harigae, Hideo; Izumi, Tohru

doi:10.1007/s00277-021-04666-x

Cited by 6 publications

(7 citation statements)

References 9 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…28 Overall, survival and normalization of platelet count were mostly attainable with first-and second-line treatments, while some cases, with refractory ITP, required second line as well as salvage therapy. 9,14,24,41,42 These results are in accordance with the overall outcome of another case series of chronic ITP patients who developed exacerbations post-COVID-19 vaccination, 12 which may indicate similarities between the course of chronic ITP and that of de novo ITP post-COVID-19 vaccination. This would help in the future when establishing standard lines of management for these conditions.…”

Section: Discussionsupporting

confidence: 85%

“…14,42 As for medications that resulted in response: 1 patient responded to mycophenolate mofetil; 2 responded to splenectomy; 1 responded to vincristine, romiplostim, and danazol; and 1 responded to romiplostim. 9,14,24,41,42 Improvement was seen from 22 to 42 days. Our case failed to respond to intravenous steroids, IVIG, rituximab, anti-RhD immunoglobulin, and eltrombopag.…”

Section: Discussionmentioning

confidence: 90%

“…Among all these case series and reports, only 1 reported the use of vincristine, with a remarkable resulting response, making this study one of the first reports supporting the use of vincristine as a last resort in severe refractory ITP induced by the COVID-19 vaccine. 41 In all but 1 case (where IVIG was used as first-line treatment without steroids) corticosteroids including prednisone, prednisolone, dexamethasone, methylprednisolone, hydrocortisone, and pulse steroids, were used. 36 The doses of steroids and IVIG varied according to patient weight.…”

Section: Discussionmentioning

confidence: 99%

See 2 more Smart Citations

COVID‐19‐induced immune thrombocytopenia management approach: A case report and literature review

Alahwal,

Alsharif,

Alsharif

et al. 2024

Clinical Case Reports

View full text Add to dashboard Cite

Key Clinical MessageVincristine therapy can be effective in refractory Immune thrombocytopenia (ITP) following COVID‐19 vaccination. Our case report highlights the need for further research to establish standard management guidelines for COVID‐19‐vaccine‐associated ITP.AbstractAdult immune thrombocytopenia (ITP) can occur as a rare complication following several viral infections or a rare adverse event or complication of vaccination. In this paper, we report a case of a 39‐year‐old male patient with severe refractory ITP that began 4‐weeks after receiving his third (booster) dose of the COVID‐19 vaccine (BNT162b2, Pfizer‐BioNTech). He was given oral dexamethasone 40 mg daily for 4 days followed by prednisone at 1 mg/kg (85 mg daily) for 10 days. In the following weeks, we attempted several other lines of therapy to treat his ITP, including anti‐RhD immunoglobulin, which, unfortunately, caused moderate hemolysis requiring packed red blood cell transfusion, intravenous immunoglobulin (given at a subtherapeutic dose of 0.4 g/kg for only 1 day since it was not available), rituximab, and eltrombopag. The patient, unfortunately, showed no response to any of these treatments. This was an indicator to initiate salvage therapy with vincristine 2 mg weekly for 3 weeks. The patient's platelet count started to increase remarkably during the third week of vincristine and normalized after 4 weeks. We review the findings, clinical characteristics, and management approaches that were reported in the literature regarding COVID‐19‐vaccine‐induced ITP. More in‐depth research is needed to delineate standard guidelines for the management of such cases. This report underscores the importance of resorting to vincristine and eltrombopag as great options for severe and refractory ITP related to the COVID‐19 vaccine.

show abstract

Section: Discussionsupporting

confidence: 85%

Section: Discussionmentioning

confidence: 90%

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

COVID‐19‐induced immune thrombocytopenia management approach: A case report and literature review

Alahwal,

Alsharif,

Alsharif

et al. 2024

Clinical Case Reports

View full text Add to dashboard Cite

show abstract

“…These findings directly indicated that B cell germinal center responses are positively correlated with C19-VAL incidence. Four case reports showed that pathogen reactivation (TB (n = 1) [ 66 ] and EBV(n = 1) [ 89 ]), iMDC (n = 1) [ 90 ] and autoimmune disease (ITP) (n = 1) [ 41 ] are correlated with C19-VAL development. Those findings indicated that reactive change is also related to C19-VAL development.…”

Section: Resultsmentioning

confidence: 99%

“…The reactive change was also discovered in the lymph node from C19-VAL, displaying its involvement in the cause of C19-VAL [ 8 , 35 , 36 , 37 ]. In addition, other reports show that C19-VAL incidence is associated with age and gender [ 13 , 38 ], even occurring in other adverse vaccinal effects such as Kikuchi-Fujimoto disease [ 39 , 40 ] and autoimmune disease [ 41 ]. In this study, we aimed to construct a systematic review that not only analyzed the associated effects in the incidence of C19-VAL, but also explored the mechanism of C19-VAL.…”

Section: Introductionmentioning

confidence: 99%

Immune Response Related to Lymphadenopathy Post COVID-19 Vaccination

Shen

Chang

et al. 2023

Vaccines

View full text Add to dashboard Cite

Mass vaccination against coronavirus disease 2019 (COVID-19) is a global health strategy to control the COVID-19 pandemic. With the increasing number of vaccinations, COVID-19 vaccine-associated lymphadenopathy (C19-VAL) has been frequently reported. Current findings emphasize the characteristics of C19-VAL. The mechanism of C19-VAL is complicated to explore. Accumulated reports separately show that C19-VAL incidence is associated with receiver age and gender, reactive change within lymph nodes (LN), etc. We constructed a systematic review to evaluate the associated elements of C19-VAL and provide the mechanism of C19-VAL. Articles were searched from PubMed, Web of Science and EMBASE by using the processing of PRISMA. The search terms included combinations of the COVID-19 vaccine, COVID-19 vaccination and lymphadenopathy. Finally, sixty-two articles have been included in this study. Our results show that days post-vaccination and B cell germinal center response are negatively correlated with C19-VAL incidence. The reactive change within LN is highly related to C19-VAL development. The study results suggested that strong vaccine immune response may contribute to the C19-VAL development and perhaps through the B cell germinal center response post vaccination. From the perspective of imaging interpretation, it is important to carefully distinguish reactive lymph nodes from metastatic lymph node enlargement through medical history collection or evaluation, especially in patients with underlying malignancy.

show abstract

Multiple drugs

2022

Reactions Weekly

View full text Add to dashboard Cite

Vincristine therapy for severe and refractory immune thrombocytopenia following COVID-19 vaccination

Cited by 6 publications

References 9 publications

COVID‐19‐induced immune thrombocytopenia management approach: A case report and literature review

COVID‐19‐induced immune thrombocytopenia management approach: A case report and literature review

Immune Response Related to Lymphadenopathy Post COVID-19 Vaccination

Multiple drugs

Contact Info

Product

Resources

About