Reevaluation of the role of vincristine in the treatment of newly diagnosed chronic idiopathic thrombocytopenic purpura in adults

Abstract

Idiopathic thrombocytopenic purpura (ITP) is the most common acqmres hemostatic disorder. Various treatment modalities were extensively studied, with steroids, currently, being the accepted initial line of therapy, followed by splenectomy in cases that are steroid refractory or dependant. Cases showing no response to splenectomy, or recuring after it, •are considered refractory, and various treatment modalities are tried in these cases with variable results. In this study, 40 adult cases with ITP, all within the tlrst 6 month from diagnosis, are included. Twenty were treated by conventional steroid therapy, prednisone lmg!kg/day, and the remaining 20 were treated by vincristine 1.5 mg/m2/week for 4 weeks. Patients were followed up during treatment and for 2 years thereafter. Initial responses to vincristine were superior to steroids, with statistically significant increased response rates during the first week, and the first Jew months, as compared to steroids. Indeed follow up of patients over 2 years showed no added benefit over steroids, with most cases• relapsing thereafter and requiring further lines of therapy.