Refractory splenectomized immune thrombocytopenic purpura: Does vincristine have a role after thrombopoietin receptor agonist failure?

Introduction The treatment options for patients with refractory splenectomized chronic immune thrombocytopenic purpura (ITP) are often unsatisfactory despite different lines of treatment, especially after thrombopoietin receptor agonist (TPO-RA) failure. Objective This study was done to assess the efficacy of vincristine in the treatment of patients with splenectomized chronic ITP who failed TPO-RA therapy as well as their 8-month follow-up following vincristine discontinuation. Patients and methods A total of 12 patients with splenectomized chronic ITP who failed to respond to TPO-RA were treated with vincristine 1–2 mg weekly for 6 weeks. Results The platelet count was evaluated during the treatment, and every 2 months for 8-month follow-up. The mean platelet count was significantly increased at the third, fourth, fifth, and sixth weeks during the treatment and persistently elevated during the second, fourth, and sixth months of follow-up when compared with the baseline platelet count, while decreasing at the 8-month follow-up, with no significant difference at their baseline. Conclusion Vincristine could be an effective treatment in patients with splenectomized ITP who failed to respond to TPO-RAs and in patients requiring a short-term increase in the platelet count.

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