ISSN : 2146-3123
E-ISSN : 2146-3131

Vincristine as an Adjunct to Therapeutic Plasma Exchange for Thrombotic Thrombocytopenic Purpura: A Single Institution Experience
Şeniz Öngören1, Ayşe Salihoğlu1, Tuğçe Apaydın2, Sevil Sadri1, Ahmet Emre Eşkazan1, Muhlis Cem Ar1, Tuğrul Elverdi1, Zafer Başlar1, Yıldız Aydın1, Teoman Soysal1
1Department of Internal Medicine, Division of Hematology, İstanbul University Cerrahpaşa School of Medicine, İstanbul, Turkey
2Department of Internal Medicine, İstanbul University Cerrahpaşa School of Medicine, İstanbul, Turkey
DOI : 10.4274/balkanmedj.2017.1215

Background: Thrombotic thrombocytopenic purpura (TTP) is a potentially life-threatening condition. Although introduction of therapeutic plasma exchange (TPE) has reduced mortality rates from over 90% to 10-20%, approximately 40% of patients relapse and refractory patients might have fatal outcomes. There is clearly a need for additional therapeutic approaches. The anti-CD20 monoclonal antibody rituximab has been reported to result in high response rates. Vincristine (VCR) might offer a considerable alternative.
Aims: To describe the outcomes of relapsed/refractory TTP patients treated with VCR as an adjunct to TPE.
Study Design: This single-center study is a retrospective cross-sectional study of 15 relapsed/refractory patients with TTP who were treated with VCR. Methods: The medical records of all relapsed/refractory patients with TTP treated with VCR adjunct to TPE between October 2000 and December 2016 were retrospectively reviewed. TTP diagnosis was based on clinical history, physical examination, and laboratory examinations. Patient demographics, laboratory findings, initial date and duration of TPE, the dosage and time of administration of VCR, and outcomes were recorded.
Results: There were 15 patients (median age: 37 years (range: 26-65); 7 women and 8 men) with either relapsed or refractory TTP who were treated with VCR as an adjunct to TPE in 22 episodes. Eighty-seven percent of the 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. VCR was well tolerated with no safety concerns.
Conclusion: VCR offers a reasonable option for the treatment of patients with relapsed/refractory TTP. Further studies evaluating VCR in the frontline and relapsed/refractory settings are needed to validate the role of VCR in TTP patients.

Keywords : Plasma exchange, purpura, thrombotic thrombocytopenic, vincristine
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