Autologous ¹¹¹In‐labelled platelet sequestration studies in patients with primary immune thrombocytopenia (ITP) prior to splenectomy: a report from the United Kingdom ITP Registry

Abstract

SummaryWhile splenectomy is an effective therapy for primary immune thrombocytopenia (ITP), possible complications and observed noncomplete response (CR) in one-third of patients demonstrate the need for further research into potential pre-surgical predictors of outcomes. Past investigations into platelet sequestration studies, a hypothesized predictive test, have adopted heterogeneous methods and varied widely with regard to power. By studying patients with primary ITP who underwent autologous 111 In-labelled platelet sequestration studies at Barts and The London NHS Trust between 1994 and 2008, we evaluated the effectiveness of sequestration site in predicting short, medium, and long-term CR (platelet count >100 · 10 9 /l) to splenectomy through multivariate (gender, age at splenectomy, and mean platelet lifespan) logistic regression modelling. In total, 256 patients with primary ITP underwent scans; 91 (35AE5%) proceeded to splenectomy. Logistic regression revealed significant adjusted odds ratios for CR of 7AE47 (95% confidence interval [CI], 1AE89-29AE43) at 1-3 months post-splenectomy, 4AE85 (95% CI, 1AE04-22AE54) at 6-12 months postsplenectomy, and 5AE39 (95% CI, 1AE34-21AE65) at last follow-up (median: 3AE8 years [range: 0AE5-13AE1 years]) in patients with purely or predominantly splenic versus mixed or hepatic sequestration. These findings demonstrate the utility of autologous 111 In-labelled platelet sequestration studies as an adjunct predictive instrument prior to splenectomy.

Splenectomy as a curative treatment for immune thrombocytopenia: a retrospective analysis of 233 patients with a minimum follow up of 10 years

“…In this regard, other prognostic parameters should be explored before splenectomy, particularly radio-labeled platelet scans. 23,24 The analysis of the 95 patients (41%) who did not achieve a stable response showed that, despite most of them needing multiple lines of further treatments, a new response was achieved in 83% of the cases, confirming that splenectomy can convert refractory patients into responding ones, and does not exclude the possibility of a second response in relapsing patients. 19,20 Indeed, only 16 patients (7%) did not respond to any further treatment and only 3 (1%) died of bleeding complications.…”

Romiplostim safety and efficacy for immune thrombocytopenia in clinical practice: 2-year results of 72 adults in a romiplostim compassionate-use program

“…However, conflicting results have been reported regarding the value of this complementary investigation to predict splenectomy outcome. 18,19 Future studies focusing on the predictive value of platelet-longevity scintigraphy may help determine better whether a patient could benefit from romiplostim before undergoing splenectomy.…”

The scintigraphic index spleen/liver at 30 minutes predicts the success of splenectomy in persistent and chronic primary immune thrombocytopenia

“…Recently, Sarpatwari et al [24] applied the S/L ratio described by Najean et al [34] in 72 patients after splenectomy. Between 6 and 12 month postsurgery a CR was observed in 87.0% of the patients with a purely or predominantly splenic destruction pattern and only in 27.8% of the patients with a mixed or hepatic destruction pattern.…”

“…In contrast, there was a significant consensus in considering that the scintigraphic proof of the spleen as the main site of platelet destruction was the most valuable parameter for predicting a favorable outcome of splenectomy. Different scintigraphic indices have been proposed for this evaluation, such as spleen/liver [15,[22][23][24], spleen/heart [14] and spleen/spleen [13,25] at different times after the injection of autologous 111…”