Vincristine efficacy and safety in treating immune thrombocytopenia: a retrospective study of 35 patients

Abstract

Although vincristine (VCR) is sometimes prescribed for newly diagnosed immune thrombocytopenia (ITP), its efficacy in refractory ITP and sustained efficacy has yet to be demonstrated. We describe our clinical experience and recommend vincristine's correct place in ITP management. This retrospective study analysed data from 35 patients with newly diagnosed (ND), persistent (P) or chronic (C) ITP treated with VCR. The initial response rate, defined as >30 × 10(9) platelets/L, reached 86% after a median of 7 [interquartile range (IQR) 6-13] days. In ND and P ITP, even when previous therapies were inefficient, initial response was 87.5%, suggesting that this treatment could be used particularly in rescue. Median survival time, without failure or relapse, was 15 months (Kaplan-Meier curve). Predictive factors (univariate analysis) of an initial and long-term response were a small number of prior treatments received. However, at 2 yr, only seven patients had sustained response. Eight (23%) patients experienced adverse events: neuropathy for seven and bowel obstruction for one. Vincristine efficacy in ITP was confirmed, and it could be a good strategy for treating resistant ITP, especially in emergencies. In this era of new therapeutics, VCR deserves to remain on the list of ITP treatments because of its initial efficacy, safety and low cost.

How we manage immune thrombocytopenia in the elderly

“…It has been shown that platelet transfusions in this situation could lead to the cessation of bleeding without any serious effects (Salama et al, 2008). Vinca alkaloids (vincristine or vinblastine) could be added in case of severe bleeding but with risk of peripheral neuropathy especially in older patients (Stirnemann et al, 2016). We prefer to use vinblastine (5 mg/m 2 intravenously, not more than 8 mg) rather than vincristine because it is better tolerated in our experience.…”

How I treat refractory immune thrombocytopenia

“…Evidence for vinca alkaloids (VAs) is drawn mostly from studies conducted in the 1970s and 1980s, with few reports from the modern era. [48][49][50][51][52][53][54][55][56][57] Published studies vary in which VAs were used (vincristine vs vinblastine), the dose and number of infusions, use of maintenance dosing, and definition of response. Although initial reports were promising, relatively poor durability of response has dampened enthusiasm for VAs.…”

“…However, later studies found that most responses were transient. [48][49][50][51]53 In a prospective trial, 35% of patients treated with vincristine achieved a platelet count .100 3 10 9 /L, but a 40% decline in the platelet count was observed as soon as 8 weeks after completion of 3 infusions. 51 The fleetingness of response to VAs must be balanced against their toxicities, which include vesication, constipation, and peripheral neuropathy (symptoms generally arise after cumulative vincristine doses of 30 to 50 mg).…”

Is there still a place for “old therapies” in the management of immune thrombocytopenia?

“…Studies that included more than 10 patients are reported in Table 3 [62][63][64][65][66]. The efficacy of vinca-alkaloids seems to be higher in newly diagnosed ITP than in persistent and chronic ITP.…”

“…However, refractory ITP patients could benefit from vinca-alkaloids [67]. Usually, vincristine is used at a dosage of 1 mg/week, no longer than 4 weeks [65]. Vinca alkaloid effect is only suspensive with a sustained response of 37% and 20% at 1 and 2 years, respectively [65].…”