Vincristine as salvage treatment for refractory thrombotic thrombocytopenic purpura
ABSTRACT Vincristine (1.4 mg/m(2) on day 1, followed by 1 mg on days 4 and 7) was given to eight patients with thrombotic thrombocytopenic purpura (TTP) who were refractory to plasma exchange (n=4) or plasma infusion (n=4). Seven of eight patients (87%) achieved a complete response; one was refractory to treatment and died within a few weeks. After a median follow-up of 50 months, all responding patients are alive and well. Two patients relapsed and were successfully retreated with vincristine. Toxicity was mild, consisting of two episodes of leukopenia and one of autonomic neuropathy leading to paralytic ileus in a patient aged 70 years. We conclude that vincristine is highly effective in the treatment of patients suffering from refractory TTP, with negligible toxicity.
- [Show abstract] [Hide abstract]
ABSTRACT: Abstract - Abstract - Abstract - Abstract - Background. Vincristin is an important and fre- quently used chemoterapeutic drug in the treatment of ma- lignant lymphoproliferative disease. Among its side effects are well known bone marrow supression and polyneuropathia. But common physicians are not familiar with vincristine bowel peristaltics inhibitory effect. Patient and methods. This study presents 64-years old patient with acute lymphoblastic leukemia (ALL) who was treated with chemotherapy which included vincristine. Two weeks after the treatment started paralytic ileus developed which was la- ter sucessfully treated with laxatives and prokynetic drugs. Secondary causes for ileus development were excluded. Lite- rature data was reviewed and a higher incidence of paraly- tic ileus in vincristine treated patients was found, especially when they are given concomitant itraconazole. Our patient received concommitant itraconazole as a part of antifungal prophylaxis against invasive aspergillosis which is a perceived routine on hematological departments. Conclusions. Vincristine treated patients should be carefully observed regarding bowel peristaltics and obstipation. If ob- stipation or even paralytic ileus developes, we must stop vin- cristine therapy. All patients receiving vincristine must re- ceive fluconazol instead of itraconazol as a part of antifun- gal prophylaxis. Ključne besede: Ključne besede: Ključne besede: Ključne besede: Ključne besede: akutna limfoblastna levkemija; limfoproli- ferativna bolezen; vinkristin; itrakonazol; paralitični ileus Izvleček - Izvleček - Izvleček - Izvleček - Izvleček - Izhodišča. Vinkristin je nepogrešljiv citostatik pri zdravljenju malignih limfoproliferativnih bolezni. Med stran- skimi učinki zdravila sta dobro poznana njegov zaviralni učinek na kostni mozeg in polinevropatija. Navadno pa leče- či zdravniki prezremo njegov zaviralni učinek na črevesno peristaltiko. Bolnik in metode. Predstavljen je 64-letni bolnik z akutno lim- foblastno levkemijo (ALL), zdravljen s kombinirano kemote- rapijo, ki je vključevala tudi vinkristin. Dva tedna po začet- ku zdravljenja je prišlo do nastanka paralitičnega ileusa, ki se je razrešil po dolgotrajnem zdravljenju z odvajali in proki- netiki. S preiskavami smo izključili sekundarni vzrok za na- stanek ileusa. Ob pregledu literature smo ugotovili, da je inci- denca paralitičnega ileusa pri bolnikih, zdravljenih z vinkri- stinom, še posebej visoka, če hkrati prejemajo tudi itrakona- zol. Tudi v našem primeru je bolnik prejemal itrakonazol, ki ga na hematoloških oddelkih pogosto uporabljamo za prepre- čevanje glivičnih okužb, predvsem invazivne aspergiloze. Zaključki. Pri bolnikih, ki prejemajo vinkristin, moramo biti pozorni na pojav zaprtja. Če se pojavi zaprtje ali pa pride celo do nastanka paralitičnega ileusa, potem moramo prene- hati zdraviti z vinkristinom. Vsi bolniki, ki prejemajo vinkri- stin, naj kot protiglivično preventivno zdravljenje prejemajo flukonazol in ne itrakonazol.
- [Show abstract] [Hide abstract]
ABSTRACT: Thrombotic thrombocytopenic purpura (TTP) and hemolytic uremic syndrome (HUS) are multisystemic disorders that are characterized by thrombocytopenia, microangiopathic hemolytic anemia, and ischemic manifestations, resulting from platelet agglutination in the arterial microvasculature. Until the introduction of plasma-based therapy, TTP was associated with a mortality rate greater than 90%. Current outcomes of TTP and HUS have improved dramatically with the use of plasma exchange, which should be initiated promptly at diagnosis. Recent evidence suggests that deficiency of a specific plasma protease responsible for the physiologic degradation of von Willebrand factor plays a pathogenic role in a substantial proportion of familial and acute idiopathic cases of TTP. Although multiple triggers, such as infection, drugs, cancer, chemotherapy, bone marrow transplantation, and pregnancy, are recognized, knowledge of the pathogenesis of TTP and HUS in relationship to these disorders remains incompletely understood and continues to evolve. While uncommon, TTP and HUS are of considerable clinical importance because of their abrupt onset, fulminant clinical course, and high morbidity and mortality in the absence of early recognition and treatment.Mayo Clinic Proceedings 12/2001; 76(11):1154-62. DOI:10.4065/76.11.1154 · 6.26 Impact Factor
- [Show abstract] [Hide abstract]
ABSTRACT: To evaluate the effect of prednisone alone, compared with a combination of prednisone and vincristine, on platelet counts in bleeding dogs with severe primary immune-mediated thrombocytopenia (IMT). Prospective case study. 24 dogs with severe primary IMT PROCEDURE: All dogs received immunosuppressive doses of prednisone (1.5 to 2 mg/kg [0.7 to 0.9 mg/lb] of body weight, PO, q 12 h). In addition, 12 dogs received a single dose of vincristine (0.02 mg/kg [0.01 mg/lb], IV). Platelet count, transfusion requirement, and outcome were monitored. A response was defined as an increase in platelet count to > or = 40,000/microl. Dogs in the prednisone group that failed to respond received 1 dose of vincristine on day 7. Dogs that received prednisone and vincristine had a significantly faster increase in platelet count to > or = 40,000 platelets/microl than dogs that received prednisone alone (mean +/- SD, 4.9 +/- 1.1 vs 6.8 +/- 4.5 days, respectively). A similarly rapid response was observed in dogs that received vincristine on day 7 after treatment with prednisone alone failed. Furthermore, duration of hospitalization was reduced in the vincristine group, compared with the prednisone group (5.4 +/- 0.3 vs 7.3 +/- 0.5 days, respectively). No adverse effects attributable to vincristine were observed in any dog. Administration of combined vincristine and prednisone is associated with more rapid increase in platelet numbers and shortened duration of hospitalization in dogs with IMT, compared with use of prednisone alone. Early use of vincristine seems warranted in dogs with severe primary IMT.Journal of the American Veterinary Medical Association 02/2002; 220(4):477-81. DOI:10.2460/javma.2002.220.477 · 1.56 Impact Factor