Szczepanik A B, Sikorska A, Slomkowski M, Konopka L
Department of General and Hematological Surgery, Institute of Hematology and Transfusion Medicine, Warsaw, Poland.
Int J Lab Hematol. 2007 Oct;29(5):347-51. doi: 10.1111/j.1365-2257.2006.00891.x.
Administration of vinca alkaloids (VA) to chronic corticosteroid refractory immune thrombocytopenia (ITP) patients results in a temporary increase of platelet count. The aim of the study was to evaluate the efficacy of vinca alkaloids in preparing adult corticosteroid refractory chronic ITP patients for splenectomy as well as to compare the costs of this method with costs of applying intravenous immunoglobulins. The study included 12 chronic ITP patients refractory to corticosteroids applied for 3-144 months. The patients were prepared for splenectomy with average 3.0 (from 1 to 4) 2-h intravenous infusions of vinca alkaloids at 7 day intervals. In eight patients, vincristin was used in a total dose of 6 mg (2 mg per infusion), in two patients, vinblastin was used in total dose of 30 mg (10 mg per infusion), and in two patients, vincristin and vinblastin infusions were administered alternatively. In nine of the 12 treated patients (75%) the platelet count increased to > or = 80 x 10(9)/l, which allowed safe splenectomy. Three patients unreactive to VA treatment were prepared for splenectomy with intravenous gammaglobulin infusions. Splenectomy was performed in 12 patients, in eight with laparoscopic method, in four with classic method. No complications during surgical intervention were observed. In none of the VA treated patients was myelosupression or liver or/and kidney dysfunction observed. Splenectomy resulted in normalization of platelet count in all patients after operation and in six of nine patients followed up for 10 months (on the average). Matching of VA costs with treatment efficacy and comparison with similar costs for intravenous immunoglobulin treatment revealed many fold lower costs of the former method.
对慢性皮质类固醇难治性免疫性血小板减少症（ITP）患者使用长春花生物碱（VA）可使血小板计数暂时升高。本研究的目的是评估长春花生物碱在为成年皮质类固醇难治性慢性ITP患者进行脾切除术做准备方面的疗效，并将该方法的成本与应用静脉注射免疫球蛋白的成本进行比较。该研究纳入了12例对皮质类固醇难治的慢性ITP患者，这些患者使用皮质类固醇的时间为3至144个月。患者接受脾切除术前准备，平均每7天进行3.0次（1至4次）每次2小时的长春花生物碱静脉输注。8例患者使用长春新碱，总剂量为6mg（每次输注2mg）；2例患者使用长春碱，总剂量为30mg（每次输注10mg）；2例患者交替使用长春新碱和长春碱输注。12例接受治疗的患者中有9例（75%）血小板计数升至≥80×10⁹/L，从而能够安全地进行脾切除术。3例对VA治疗无反应的患者通过静脉输注丙种球蛋白进行脾切除术前准备。12例患者均接受了脾切除术，其中8例采用腹腔镜方法，4例采用经典方法。手术干预期间未观察到并发症。在所有接受VA治疗的患者中均未观察到骨髓抑制或肝和/或肾功能障碍。脾切除术后所有患者的血小板计数均恢复正常，9例随访10个月（平均）的患者中有6例也是如此。将VA的成本与治疗效果相匹配，并与静脉注射免疫球蛋白治疗的类似成本进行比较，结果显示前一种方法的成本要低很多倍。
