Vincristine as an Adjunct to Therapeutic Plasma Exchange for Thrombotic Thrombocytopenic Purpura: A Single-Institution Experience
Background
Thrombotic thrombocytopenic purpura is a potentially life-threatening condition. Although the introduction of therapeutic plasma exchange has reduced mortality rates from over 90% to 10%-20%, approximately 40% of patients relapse, and outcomes may be fatal in refractory patients. There is clearly a need for additional therapeutic approaches.


Aims
To describe the outcomes of relapsed/refractory thrombotic thrombocytopenic purpura patients treated with vincristine as an adjunct to therapeutic plasma exchange.


Study Design
Cross-sectional study.


Methods
The medical records of all relapsed/refractory patients with thrombotic thrombocytopenic purpura treated with vincristine adjunct to therapeutic plasma exchange between October 2000 and December 2016 were retrospectively reviewed. Diagnosis of thrombotic thrombocytopenic purpura was based on clinical history, physical examination, and laboratory examinations. Patient demographics, laboratory findings, initial date and duration of therapeutic plasma exchange, dosage and time of administration of vincristine, and outcomes were recorded.


Results
The study included 15 patients [median age: 37 years (range: 26-65); 7 women and 8 men] with either relapsed or refractory thrombotic thrombocytopenic purpura who were treated with vincristine as an adjunct to therapeutic plasma exchange for a total of 22 episodes. Eighty-seven percent of patients achieved remissions in 20 of 22 episodes, with a median duration of remission of 29.5 months (range: 3-105). After a median follow-up of 55 months, 11 patients were alive. Vincristine was well tolerated with no safety concerns.


Conclusion
Vincristine offers a reasonable option for the treatment of patients with relapsed/refractory thrombotic thrombocytopenic purpura. Further studies evaluating vincristine in the front-line setting and in the relapsed/refractory setting are needed to validate the role of vincristine in thrombotic thrombocytopenic purpura patients.
['Öngören|Seniz|S|', 'Salihoğlu|Ayşe|A|', 'Apaydın|Tuğçe|T|', 'Sadri|Sevil|S|', 'Eşkazan|Ahmet Emre|AE|', 'Ar|Muhlis Cem|MC|', 'Elverdi|Tuğrul|T|', 'Başlar|Zafer|Z|', 'Aydın|Yıldız|Y|', 'Soysal|Teoman|T|']
D000328:Adult D000368:Aged D003430:Cross-Sectional Studies D005260:Female D006801:Humans D008297:Male D008875:Middle Aged D010951:Plasma Exchange D011697:Purpura, Thrombotic Thrombocytopenic D012008:Recurrence D012189:Retrospective Studies D014421:Turkey D014750:Vincristine
vincristine Plasma exchange thrombotic thrombocytopenic purpura