JCHOR
Journal of Current Hematology & Oncology Research

The Journal of Current Hematology & Oncology Research regularly publishes internationally qualified research in hematology and oncology within the current scholarly knowledge.

ISSN: Active
eISSN: 2980-0854
Creative Commons CC BY-NC-ND 4.0 International License.
EndNote Style

Online Manuscript System

Index
Original Article
Efficacy and safety of vincristine as salvage therapy in refractory thrombotic thrombocytopenic purpura: a single center experience
Abstract
Aims: Thrombotic thrombocytopenic purpura (TTP) is a life-threatening thrombotic microangiopathy caused by severe ADAMTS13 deficiency, leading to widespread microvascular thrombosis and requiring urgent therapeutic plasma exchange (TPE) and immunosuppression. Although most patients achieve remission with first-line TPE and corticosteroids, approximately 10–40% develop refractory disease requiring additional therapies. Evidence supporting alternative salvage therapies, including vincristine, remains limited.
Methods: We conducted a retrospective single-center study of adult patients diagnosed with TTP between 2020 and 2025. All patients received first-line daily TPE plus corticosteroids. Refractoriness was defined as failure to achieve platelet recovery or biochemical improvement after 5–7 days of therapy. Patients laboratory results were obtained from the hospital's record system.
Results: A total of 25 patients were included. First-line therapy achieved remission in 48% of patients (12/25). Among 13 refractory patients, rituximab induced remission in 2 (15%). Eleven patients subsequently received vincristine salvage therapy, of whom 9 (81,8%) achieved complete remission, accompanied by rapid platelet recovery and normalization of lactate dehydrogenase levels. Two elderly patients with severe multisystem involvement died despite salvage therapy. Overall survival for the cohort was 92%.
Conclusion: Vincristine was highly effective and well tolerated as a salvage therapy in patients with refractory TTP who failed both TPE and rituximab, achieving remission in more than 80% of cases. These findings support vincristine as a valuable therapeutic option, particularly in settings where caplacizumab or other advanced biologics are unavailable. Larger prospective studies are warranted to better define its optimal timing and comparative efficacy among emerging salvage therapies.

Keywords : Thrombotic thrombocytopenic purpura, vincristine, refractory TTP, salvage therapy, plasma exchange, rituximab, ADAMTS13 deficiency

Download Article


1. Scully M, Thomas M, Underwood M, et al. Thrombotic thrombocytopenic purpura and pregnancy: presentation, management, and subsequent pregnancy outcomes.Blood. 2014;124(2):211-219. doi: 10.1182/blood-2014-02-553131
2. Subhan M, Scully M. Advances in the management of TTP. Blood Rev. 2022;55:100945. doi:10.1016/j.blre.2022.100945
3. Coppo P, Cuker A, George JN. Thrombotic thrombocytopenic purpura: toward targeted therapy and precision medicine. Res Pract Thromb Haemost. 201816;3(1):26-37. doi:10.1002/rth2.12160
4. Sayani FA, Abrams CS. How I treat refractory thrombotic thrombocytopenic purpura. Blood. 2017;130(14):1684. doi:10.1182/blood-2017-08-803171
5. Zheng XL, Vesely SK, Cataland SR, et al. ISTH guidelines for treatment of thrombotic thrombocytopenic purpura.J Thromb Haemost. 2020; 18(10):2496-2502. doi:10.1111/jth.15010
6. Cuker A, Cataland SR, Coppo P, et al. Redefining outcomes in immune TTP: an international working group consensus report.Blood. 2021; 137(14):1855-1861. doi:10.1182/blood.2020009150
7. Lemiale V, Valade S, Mariotte E. Unresponsive thrombotic thrombocytopenic purpura (TTP): challenges and solutions. Ther Clin Risk Manag. 2021;17:577-587. doi:10.2147/TCRM.S205632
8. Ferrari B, Peyvandi, F. How I treat thrombotic thrombocytopenic purpura in pregnancy. Blood. 2020;136(19):2125-2132. doi:10.1182/blood.2019000962
9. Öngören S, Salihoğlu A, Apaydın T, et al. Vincristine as an adjunct to therapeutic plasma exchange for thrombotic thrombocytopenic purpura: a single-ınstitution experience.Balkan Med J. 2018;35(6):417-421. doi:10.4274/balkanmedj.2017.1215
10. Gutterman LA, Stevenson TD. Treatment of thrombotic thrombocytopenic purpura with vincristine. JAMA. 1982;247(10):1433-1436. doi:10.1001/jama.1982.03320350037025
Article available in :
Volume 4, Issue 2, 2026
Page : 53-56
https://doi.org/10.51271/JCHOR-0082
Article Information
Received : 18 Mar 2026
Accepted : 28 Nis 2026
Published : 18 May 2026
Corresponding Author :

Vehbi Demircan: Department of Hematology, Faculty of Medicine, Dicle University, Diyarbakır, Turkiye

[email protected]
Citation : Demircan V, Karakuş A, Ayyıldız MO. Efficacy and safety of vincristine as salvage therapy in refractory thrombotic thrombocytopenic purpura: a single center experience. J Curr Hematol Oncol Res. 2026;4(2):53-56. doi:10.51271/JCHOR-0082

Read: 94
Download : 40
Cited: 0
_Footer