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September 3, 1982

Thrombotic Thrombocytopenic Purpura and Vincristine

JAMA. 1982;248(9):1063. doi:10.1001/jama.1982.03330090035013

To the Editor.—  We were interested in the recent article in The Journal (1982;247:1433) by Lorence A. Gutterman, MD, and Thomas D. Stevenson, MD, which demonstrates that vincristine sulfate is capable of inducing remissions in patients with thrombotic thrombocytopenic purpura (TTP). However, we are disturbed because one of their patients (case 4), who had aphasia and right hemiplegia, did not recover from this neurological deficit. Also, three of their patients (cases 1, 2, and 5) did not begin to recover from their neurological deficits for nine to 18 days after treatment with vincristine was initiated. We believe that these three patients were at undue risk of experiencing a major neurological event during this interval, even though they eventually attained a remission.Since there are no ongoing randomized trials, we agree with the authors and others1 that "the diagnosis of TTP usually warrants an aggressive multitherapy approach. Any therapeutic measure that