Vincristine as salvage treatment for refractory thrombotic thrombocytopenic purpura.

Vincristine (1.4 mg/m(2) on day 1, followed by 1 mg on days 4 and 7) was given to eight patients with thrombotic thrombocytopenic purpura (TTP) who were refractory to plasma exchange (n=4) or plasma infusion (n=4). Seven of eight patients (87%) achieved a complete response; one was refractory to treatment and died within a few weeks. After a median follow-up of 50 months, all responding patients are alive and well. Two patients relapsed and were successfully retreated with vincristine. Toxicity was mild, consisting of two episodes of leukopenia and one of autonomic neuropathy leading to paralytic ileus in a patient aged 70 years. We conclude that vincristine is highly effective in the treatment of patients suffering from refractory TTP, with negligible toxicity.

[Analysis of a case of multiple myeloma with late dissemination of skin nodules]. / Analisi di un caso di mieloma multiplo con disseminazione nodosa cutanea tardiva.

A case of a 55 years old woman suffering from multiple myeloma with strong bone marrow proplasmocytic infiltration, several osteolytic and osteoporotic lesions and high seric M-component level and hypertensive heart failure is described. After 32 months of partial remission obtained with cyclic chemotherapy, large cutaneous tumors arose. Despite of a new therapeutic trial, in the last 8 months, an increase of bone marrow and seric signs was observed without involvement of the lungs or kidneys or expression of plasma-cell leukemia. Death occurred at 50th month because of sepsis and heart failure. A real cutaneous tropism, late occurred and without cytohistological changes, is stressed. The meaning of the rich vascularization of the skin over the tumors in absence of inflammation and necrosis remains unclear.