Vincristine Therapy of Idiopathic and Secondary Thrombocytopenias

Idiopathic thrombocytopenia refractory to glucocorticoids and splenectomy remains a serious problem. Prompt benefit was obtained from vincristine in six of seven patients not splenectomized who were refractory to glucocorticoids and in nine of 13 patients refractory to both glucocorticoids and splenectomy. Five of the nine were also refractory to cyclophosphamide or azathioprine or both. Vincristine also benefited 10 of 10 patients with thrombocytopenia and serologic evidence of lupus erythematosus or its variants, some patients with various forms of bone-marrow insufficiency, and three of three with thrombocytopenia due to lymphocytic leukemia. Vincristine accordingly appears to be indicated in the management of several forms of thrombocytopenia refractory to splenectomy and glucocorticoids. Its value as compared to vinblastine, azathioprine, and cyclophosphamide remains to be determined. (N Engl J Med 291:376–380, 1974)