title: 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.
authors.affiliation: Hôpital Jean-Verdier, Service de Médecine Interne, Université Paris 13, Assistance Publique-hôpitaux de Paris (AP-HP), Bondy Cedex, France.|Département de Médecine Interne et de réadaptation, Hôpitaux Universitaires de Genève, Geneva, Switzerland.
authors.forename: Jérôme
authors.initials: J
authors.lastname: Stirnemann
authors.affiliation: Hôpital Jean-Verdier, Service de Médecine Interne, Université Paris 13, Assistance Publique-hôpitaux de Paris (AP-HP), Bondy Cedex, France.
authors.forename: Najett
authors.initials: N
authors.lastname: Kaddouri
authors.affiliation: Service de Médecine Interne, UPEC, Hôpital Henri-Mondor, AP-HP, Créteil Cedex, France.
authors.forename: Medhi
authors.initials: M
authors.lastname: Khellaf
authors.affiliation: Hôpital Jean-Verdier, Service de Médecine Interne, Université Paris 13, Assistance Publique-hôpitaux de Paris (AP-HP), Bondy Cedex, France.
authors.forename: Anne-Sophie
authors.initials: AS
authors.lastname: Morin
authors.affiliation: Hôpital Jean-Verdier, Service de Médecine Interne, Université Paris 13, Assistance Publique-hôpitaux de Paris (AP-HP), Bondy Cedex, France.|Département de Médecine Interne et de réadaptation, Hôpitaux Universitaires de Genève, Geneva, Switzerland.
authors.forename: Virginie
authors.initials: V
authors.lastname: Prendki
authors.affiliation: Service de Médecine Interne, UPEC, Hôpital Henri-Mondor, AP-HP, Créteil Cedex, France.
authors.forename: Marc
authors.initials: M
authors.lastname: Michel
authors.affiliation: Hôpital Jean-Verdier, Service de Médecine Interne, Université Paris 13, Assistance Publique-hôpitaux de Paris (AP-HP), Bondy Cedex, France.|Service de médecine interne, DHU i2B, Hôpital Saint Antoine, Université Paris 6, Paris, France.
authors.forename: Arsène
authors.initials: A
authors.lastname: Mekinian
authors.affiliation: Etablissement Français du Sang, Université Paris 12, Hôpital Henri-Mondor, AP-HP, Créteil Cedex, France.
authors.forename: Philippe
authors.initials: P
authors.lastname: Bierling
authors.affiliation: Service d'Hématologie Séniors, Université Paris 7, Hôpital Saint-Louis, AP-HP, Paris, France.
authors.forename: Pierre
authors.initials: P
authors.lastname: Fenaux
authors.affiliation: Service de Médecine Interne, UPEC, Hôpital Henri-Mondor, AP-HP, Créteil Cedex, France.
authors.forename: Bertrand
authors.initials: B
authors.lastname: Godeau
authors.affiliation: Hôpital Jean-Verdier, Service de Médecine Interne, Université Paris 13, Assistance Publique-hôpitaux de Paris (AP-HP), Bondy Cedex, France.|Service de médecine interne, DHU i2B, Hôpital Saint Antoine, Université Paris 6, Paris, France.
authors.forename: Olivier
authors.initials: O
authors.lastname: Fain
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000972:Antineoplastic Agents, Phytogenic / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D016553:Purpura, Thrombocytopenic, Idiopathic / Q000175:diagnosis / Q000188:drug therapy* / Q000401:mortality; D012008:Recurrence; D019233:Retreatment; D012189:Retrospective Studies; D016896:Treatment Outcome; D014750:Vincristine / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D055815:Young Adult
chemical_list: D000972:Antineoplastic Agents, Phytogenic; D014750:Vincristine
keywords: efficacy; emergency; immune thrombocytopenia; safety; vincristine