Long-term complications of splenectomy in adult immune thrombocytopenia

Abstract

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Long‐term safety and efficacy of rituximab in 248 adults with immune thrombocytopenia: Results at 5 years from the French prospective registry ITP‐ritux

“…Moreover, ITP could be associated with increased risk of thromboembolism 32,33 as well as splenectomy, performed in four of the nine patients exhibiting venous thrombosis, because of lack of sustained response with rituximab. 34,35 Several studies suggested that ITP could be associated with increased risk of hematologic malignancies. [36][37][38] In our study, we found no over-representation of late-onset malignancy, and the SIR was similar to the general French population, which gives reassuring data for the use of rituximab.…”

Splenectomy for immune thrombocytopenia: down but not out

“…We included populationbased/administrative cohort studies (N=5), retrospective (N=7) and prospective (N=2) cohort studies that reported outcomes on at least 50 patients with ITP, with a median follow up greater than 3 months. 22,55,[68][69][70][71][72] For the splenectomy patients in particular, we included only studies that reported late (>3 months) venous thromboembolism events to minimize selection bias from studies focusing on postoperative portal and splenic vein thrombosis. Time is calculated from date of splenectomy in the splenectomy group and date of enrollment in cohort for the nonFor personal use only.…”

“…65 In patients with ITP, splenectomy usually increases the platelet count, and may also result in increases in plasma cholesterol, leucocyte counts, and C reactive protein, all of which are associated with increased thrombotic risk. 71 which may be due to the prospective design with closer follow-up. However, the cohort was small and significant attrition resulted in few patients followed beyond 20 years.…”

Phase 1b trial of pembrolizumab monotherapy for relapsed/refractory multiple myeloma: KEYNOTE‐013

“…Kaplan-Meier estimates of (A) progression-free survival and (B) overall survival based on International Myeloma Working Group uniform response criteria per site review. Autologous 111 Indium-oxinate-labelled platelet sequestration study in patients with immune thrombocytopenia treated by thrombopoietin receptor-agonists An increasing number of patients treated with thrombopoietin receptor-agonists (TPO-Ras) for immune thrombocytopenia (ITP) are reluctant to undergo splenectomy mostly because of the irreversibility of the procedure and concerns about its long-term safety (Kojouri et al, 2004;Boyle et al, 2013;Thai et al, 2016). Isotopic assessment of the site of platelet destruction using autologous 111 Indium-oxinatelabelled platelet kinetic study might help to determine whether or not splenectomy is indicated in these patients (Najean et al, 1997;Sarpatwari et al, 2010;Palandri et al, 2014).…”