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Slow Infusion of Vinca Alkaloids in the Treatment of Idiopathic Thrombocytopenic Purpura

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Grant support: by grants 5R01 AM 25485 and 5M01 RR 00261 from the National Institutes of Health; Miami Veterans Administration Merit Review Award 0215-01; and the Women's Cancer Association; and research funds given in honor of Mary Beth Weiss, Kenneth Chasen, Joseph Peter Siegel, H. Spencer Lichte, Steven Andrew deYoung, Marion Powers, and Stuart W. Patton.

Presented in part on 19 January 1979 at the meeting of the Southern Society of Clinical Investigation; New Orleans, Louisiana.

▸Requests for reprints should be addressed to Yeon S. Ahn, M.D.; Center for Blood Diseases, University of Miami School of Medicine, P.O. Box 016760 (R-36); Miami, FL 33101.

Miami, Florida

© 1984 American College of PhysiciansAmerican College of Physicians

Ann Intern Med. 1984;100(2):192-196. doi:10.7326/0003-4819-100-2-192
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Vinca alkaloids are useful in the treatment of idiopathic thrombocytopenic purpura, a disorder in which macrophages remove platelets sensitized with antibody. Because vinca alkaloids avidly bind to platelets, drugs can be delivered selectively to macrophages. However, drugs given by bolus injection are cleared too rapidly to bind optimally to autologous platelets, and the use of allogeneic platelets loaded with drug in vitro is cumbersome, expensive, and dangerous. Therefore, slow infusions were devised to prolong the duration of enhanced plasma drug concentrations, thereby providing better conditions for in-vivo drug loading into autologous platelets. Twenty-four patients with refractory idiopathic thrombocytopenic purpura were given slow infusions; 17 had good to excellent responses. Eleven of eighteen patients who had been treated with bolus injections had better results when treated with slow infusions. Patients with improved responses had slower plasma clearance rates than did patients with poor responses. Slow infusion therapy had fewer side effects than bolus injection therapy. Slow infusions are the best method for long-term management.





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