Vincristine as salvage treatment for refractory thrombotic thrombocytopenic purpura

Ferrara, Felicetto; Copia, Carolina; Annunziata, Mario; Spasiano, Anna; Grazia, Carmen Di; Palmieri, Salvatore; Prossomariti, Luciano; Mele, Giuseppina

doi:10.1007/s002770050549

Cited by 37 publications

(35 citation statements)

References 12 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…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.…”

Section: Discussionsupporting

confidence: 69%

See 1 more Smart Citation

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

Elrewihby¹,

Zaghloul²,

Saber³

et al. 2017

J Blood Disord Transfus

View full text Add to dashboard Cite

show abstract

Section: Discussionsupporting

confidence: 69%

“…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].…”

Section: Discussionmentioning

confidence: 99%

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

Elrewihby¹,

Zaghloul²,

Saber³

et al. 2017

J Blood Disord Transfus

View full text Add to dashboard Cite

show abstract

“…[59][60][61] The side-effect profile includes mild peripheral paresthesias, muscle weakness, paralytic ileus, leukopenia, and transient alopecia. 62 Vincristine may work better when used in the initial treatment of patients with TTP, rather than for treating refractory patients.…”

mentioning

confidence: 99%

How I treat refractory thrombotic thrombocytopenic purpura

Sayani¹,

Abrams

2015

Blood

145

143

View full text Add to dashboard Cite

Acquired thrombotic thrombocytopenic purpura (TTP) is characterized by thrombocytopenia and microangiopathic hemolytic anemia (MAHA) without an obvious cause, and may include fever, mild renal failure, and neurologic deficits. It is characterized by a deficiency of the von Willebrand factor (VWF) cleaving enzyme, ADAMTS13 (a disintegrin and metalloproteinase, with a thrombospondin type 1 motif, member 13), resulting in formation of microthrombi in the high sheer environment of the microvasculature. This causes microvascular occlusion, MAHA, and organ ischemia. Diagnosis is based on the presence of clinical symptoms, laboratory aberrations consistent with MAHA, decreased ADAMTS13 activity, and possibly presence of anti-ADAMTS13 autoantibodies. Upfront treatment of acute TTP includes plasma exchange and corticosteroids. A significant number of patients are refractory to this treatment and will require further interventions. There are limited data and consensus on the management of the refractory TTP patient. Management involves simultaneously ruling out other causes of thrombocytopenia and MAHA, while also considering other treatments. In this article, we describe our management of the patient with refractory TTP, and discuss use of rituximab, increased plasma exchange, splenectomy, and immunosuppressive options, including cyclophosphamide, vincristine, and cyclosporine. We also review recent evidence for the potential roles of bortezomib and N-acetylcysteine, and explore new therapeutic approaches, including recombinant ADAMTS13 and anti-VWF therapy. (Blood. 2015;125(25):3860-3867) Case A 25-year-old previously healthy woman presented with a 3-day history of fatigue, nausea, abdominal pain, and easy bruising. She was alert, oriented, afebrile, had mild abdominal tenderness, and purpura on her extremities. Her hemoglobin was 8.4 g/dL; platelets, 15 3 10 9 /L; creatinine, 1.1 mg/dL; and her lactate dehydrogenase and reticulocytes were increased. Schistocytes and nucleated red blood cells were easily seen on her peripheral blood smear. In the absence of other obvious precipitators of thrombocytopenia and microangiopathic hemolytic anemia (MAHA), she was diagnosed with acquired thrombotic thrombocytopenic purpura (TTP). Blood samples were sent for ADAMTS13 (a disintegrin and metalloproteinase, with a thrombospondin type 1 motif, member 13) activity and inhibitor levels, and the patient was immediately started on plasma exchange (PEX) and prednisone 1 mg/kg per day. She responded well initially, and her platelets rose to 105 000/mL on day 4. However, on day 5, she was febrile and her platelets dropped to 40 000/mL. BackgroundAcquired TTP was initially characterized by thrombocytopenia, MAHA, renal failure, neurologic deficits, and fever. However, it is now well accepted that neither renal failure nor high fevers are key diagnostic features. Thrombocytopenia and MAHA are required for diagnosis when TTP is suspected. TTP is a hematologic emergency, with a mortality of 90% if untreated. Treatment with PEX and cortico...

show abstract

“…Durante los últimos años, varios trabajos prospectivos han tenido buenos resultados con su utilización, como terapia inicial y de rescate. En éstos se usó la plasmaféresis más un esquema de vincristina en una dosis inicial que variaba entre 1mg al día y 1,4 mg por m 2 , seguido por 3 dosis de 1 mg cada una día por medio 5,9,10,[14][15][16][17] . Diferente a nuestro caso, limitado por costos.…”

Section: Discussionunclassified

Púrpura trombocitopénico trombótico con respuesta exitosa a vincristina

Espinoza¹,

Leal²,

Arenas

2007

Rev. méd. Chile

View full text Add to dashboard Cite

(Rev Méd Chile 2007; 135: 1572-6l púrpura trombocitopénico trombótico (PTT) forma parte del grupo de las microangiopatías trombóticas. En él se produce una agregación plaquetaria microvascular con formación de microtrombos plaquetarios sin fibrina. Se caracteriza por trombocitopenia, anemia hemolítica microangiopática, fiebre, compromiso neurológico y renal. Tiene una mortalidad cercana a 20%.Presentamos un caso de PTT, sin respuesta al tratamiento clásico, en el que se logra una rápida mejoría con vincristina. CASO CLÍNICOHombre de 24 años, previamente sano. Consultó por cuadro de 7 días de evolución de dolor cólico en fosa lumbar izquierda, asociado a hematuria moderada. Se diagnosticó un cólico renal, indicán-dose tratamiento ambulatorio. En los siguientes cuatro días tuvo una evolución tórpida, agregán-dose compromiso del estado general y disnea severa. Al examen físico se encontró febril, ictéri-co y con lesiones purpúricas en brazos.El cuadro clínico empeoró en las primeras horas de hospitalización, con generalización del púrpura y compromiso de conciencia que culminó en una convulsión tónico-clónica, sin focalización neurológica ni signos meníngeos. Se decidió ingreso a la

show abstract

Vincristine as salvage treatment for refractory thrombotic thrombocytopenic purpura

Cited by 37 publications

References 12 publications

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

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

How I treat refractory thrombotic thrombocytopenic purpura

Púrpura trombocitopénico trombótico con respuesta exitosa a vincristina

Contact Info

Product

Resources

About