Clinical efficacy and tolerability of vincristine in splenectomized patients with refractory or relapsed immune thrombocytopenia: a retrospective single-center study

Therapeutic options for immune thrombocytopenia (ITP) patients after splenectomy failure are limited. In the present study, we evaluated the role of vincristine in patients who relapsed after or were refractory to splenectomy for ITP. Sixty-two ITP patients treated with vincristine after splenectomy were retrospectively analyzed. Vincristine was administered in doses of 1.5 or 2 mg by 2-h intravenous infusion every 7 days for 4 weeks. Twenty-six (41.9 %) and 36 (58.1 %) patients were in the persistent and chronic phases of ITP, respectively. Most patients (67.7 %) received four doses of vincristine. Two months after starting vincristine, 47 (75.8 %) patients had achieved an overall response, at a median time to response of 9 days after the first dose. There was no difference in the response rate for different ITP phases, vincristine dose received, or response to splenectomy. Thirty-two (68 %) and 24 (51.1 %) of the responders maintained the response for 6 months and 1 year, respectively. Relapse occurred mostly within 6 months, with a median relapse-free survival of 12.5 months; thereafter, a durable response was observed. The administration of vincristine was well tolerated in all patients, with grade 1 peripheral neuropathy being the most common adverse event. Our study suggests that vincristine may be an effective therapeutic option, with acceptable toxicity, for salvage treatment of ITP after splenectomy.