Role Of Vincristine In Treatment Of Refractory Idiopathic Thrombocytopenic Purpura (Itp)

Chronic immune thrombocytopenia (ITP) is a condition associated with significant morbidity; however the management options for refractory ITP are often unsatisfactory despite various lines of treatment including splenectomy. The comparison of vincristine costs with other lines of treatment as intravenous immunoglobulin revealed many folds lower costs of vincristine. The aims of this study are: to evaluate the role of vincristine in treating (splenectomized and non splenectomized) refractory ITP patients who are resistant to corticosteroids therapy, to assess the use of vincristine in clinical situations requiring increase in the platelet count as a preoperative management and to evaluate the long term (6 months) follow up effect after stoppage of vincristine treatment in refractory ITP patients. Patients and Methods: Twenty nine refractory ITP patients with maximum dose of corticosteroids ( 21 of them non-splenectomized "group I" and the remaining 8 splenectomized " group II") were treated with twohour intravenous infusion of vincristine (1-2 mg) once a week for 6 weeks . In every patient, the platelet count was evaluated just before and just after the infusion of vincristine, follow up of these patients for 6 months after stoppage of vincristine was by evaluating platelet count every 2 months . Patients with hepatitis and chronic liver diseases were excluded from this study. Results: a significant increased level of the mean platelet count was observed in "group I" after the 2nd week of vincristine treatment (p <0.005) and after the 3rd , 4th , 5th and 6th week of vincristine treatment (p<0.001) when compared to before the use of vincristine . Also there was statistically significant increase of the mean platelet count in "group II" after the 3rd, 4th, 5th and 6th weeks of vincristine treatment than before the use of vincristin treatment (p< 0.05) for all comparison , the study also revealed that " group II" had a significantly increased mean platelet count than "group I" after the 4th week of vincristine treatment (p< 0.05) , while no significant differences could be detected after the 1st , 2nd ,3rd , 5th and 6th weeks of vincristine treatment. A persistent increase of the mean platelet count was observed after 2 , 4 and 6 months follow up after stoppage of vincristine treatment when compared with the mean platelet count before the use of vincristin treatment in "group I" (p<0.001 , p< 0.05 and p< 0.05 ) respectively and in "group II" (p< 0.05 ) for all comparisons. Higher mean value of platelet count was observed after 4 and 6 months of stoppage of vincristine treatment among "group II" than "group I" with no statistically significant difference, while this comparison was statistically significant after 2 months of stoppage of vincristine treatment (p< 0.05). Conclusion: Administration of vincristine to chronic corticosteroid refractory (ITP) patients was associated with a significant increased platelet count in both non splenectomized "group I" and splenectomized "group II" and this increase was persistent after stoppage of vincristine treatment for 6 month.