Vincristine efficacy and safety in treating immune thrombocytopenia: a retrospective study of 35 patients
Vincristine efficacy and safety in treating immune thrombocytopenia: a retrospective study of 35 patients
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DOI：
10.1111/ejh.12586
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发表时间：
2016-03-01
影响因子：
3.1
通讯作者：
Fain, Olivier
中科院分区：
文献类型：
--
作者：
Stirnemann, Jerome;Kaddouri, Najett;Fain, Olivier
虽然长春新碱(VCR)有时用于治疗新诊断的免疫性血小板减少症(ITP)，但其对难治性ITP的疗效和持续疗效尚未得到证实。我们描述了我们的临床经验，并推荐长春新碱在ITP治疗中的正确位置。这项回顾研究分析了35例初诊(ND)、持续性(P)或慢性(C)ITP患者接受VCR治疗的资料。最初的应答率，定义为30x10(9)个血小板/L，在中位数7[四分位数范围6-13]天后达到86%。在ND和P ITP中，即使以前的治疗无效，初步有效率仍为87.5%，提示这种治疗方法特别适用于抢救。无失败或复发的中位生存期为15个月(Kaplan-Meier曲线)。初始和长期反应的预测因素(单变量分析)是先前接受的少量治疗。然而，在2年时，只有7名患者有持续的反应。8名患者(23%)经历了不良事件：7名患者出现神经病变，1名患者出现肠梗阻。长春新碱在ITP中的疗效已得到证实，它可能是治疗难治性ITP的良好策略，尤其是在紧急情况下。在这个新疗法的时代，VCR因其最初的有效性、安全性和低成本而值得继续留在ITP治疗的名单上。
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 >30x10(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 15months (Kaplan-Meier curve). Predictive factors (univariate analysis) of an initial and long-term response were a small number of prior treatments received. However, at 2yr, 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.