Childhood immune thrombocytopenia (ITP) has a favorable outcome in most cases but severe bleeding may occur, mostly in children with very low platelet counts. Although first-line therapies are well defined, management of refractory ITP is not consensual. Vinblastine (VBL) is one second-line treatment in adult series. We reported all childhood refractory ITP treated with VBL in our unit in past 10 years. VBL was administered by four weekly injections (6 mg/m(2)/dose) in initial phase, followed by maintenance phase according to response and tolerance. Seventeen patients with refractory ITP, significant clinical bleeding (Buchanan bleeding score = 3), and platelet-count <20 x 10(9)/L were treated with VBL. In the initial phase, response rate was 11/17. In these 11 patients, response rate in maintenance was 8/11 (in combination therapies in three cases) with a median duration of VBL treatment of 13 months (2-83); 1/11 had a loss of response and 2/11 stopped treatment because of side effect. Eleven patients had side effects, mainly neuropathic pain, completely reversible after dose reduction or treatment interruption. We conclude that VBL could be considered in the treatment schedule of childhood ITP: it could rapidly increase platelet count and sustain response, if necessary in combination therapies.