Vincristine therapy for thrombotic thrombocytopenic purpura

Abstract

Thrombotic thrombocytopenic purpura (TTP) is a rare disorder characterized by microangiopathic haemolytic anemia, consumption thrombocytopenia, renal impairment, neurological dysfunction, and fever, but all these features are not present in every patient. Although the prognosis of TTP has improved since it was demonstrated that large volumes of fresh frozen plasma (FFP) lead to a remission in most patients, the disease remains fatal in many instances. Therefore, other therapies are often used in TTP, but there is skepticism about their value, since such treatments are often used in combination, making evaluation difficult. This report describes three patients with TTP and a consistent therapeutic response occurring 5 days after vincristine in each of four instances.

Thrombotic Thrombocytopenic Purpura Refractory to Plasmapheresis Treated Successfully with Vincristine: A Case Report

“…The platelet count began to increase reaching 65,000 /mm³ after 3 days of starting VCR and 175,000 /mm³ after 8 days. The total dose of VCR given to the patient was 4 mg without apparent side effects and this agrees with some studies using doses ranging from 2 mg up to 14 mg (24)(25)(26)(27)(28)(29)(30)(31)(32)(33)(34). Ziman et al, reported 100 percent survival in their retrospective data of 12 TTP patients (PLT counts ranging 4,000/mm³ to 36,000/mm³) treated with standardized protocol of PE and VCR without side effects.…”

“…Successful vincristine use has been described in various small studies and case reports, usually as a rescue therapy in refractory TTP [17,[24][25][26][27][28][29][30][31][32][33].…”

Efficiency of curative and prophylactic treatment with rituximab in ADAMTS13-deficient thrombotic thrombocytopenic purpura: a study of 11 cases

“…In these patients, complementary treatments, including immunosuppressive agents (corticosteroids, vincristine, cyclophosphamide, azathioprine, cyclosporine A), high-dose intravenous immunoglobulin (Ig), staphylococcal protein A immunoadsorption, and splenectomy, have been proposed. [7][8][9][10][11] Despite all these therapeutic options, about one third of all patients with acquired TTP develop multiple relapses or persistent disease. 1 The prediction of which patients are at high risk of either prolonged course or short-or long-term relapses remains a challenging issue.…”

Minimal evidence of platelet and endothelial cell reactive antibodies in thrombotic thrombocytopenic purpura

“…In addition to corticosteroids, immune modulating agents such as vincristine, cyclosporin, azathioprine, intravenous immunoglobulin, and staphylococcal protein A adsorption column therapy have been reported to be effective in some patients [11][12][13][14][15][16].…”