Long-term outcome following splenectomy for chronic and persistent immune thrombocytopenia (ITP) in adults and children

Abstract

The purpose of this research is to study the outcomes of splenectomy for chronic and persistent immune thrombocytopenia (ITP). This study is a retrospective analysis of 254 patients with chronic or persistent ITP who underwent splenectomy at CMC, Vellore, India between 1995 and 2009. Responses were assessed based on standard criteria. One hundred and sixty seven adults and 87 children with a median age of 29 years (range 2-64) with persistent (n = 103) or chronic ITP (n = 151) was studied. Response was seen in 229 (90.2 %) including CR in 74.4 % at a median time of 1 day (range 1-54). Infections following splenectomy were reported in 16 %. Deaths related to post splenectomy sepsis occurred in 1.57 % and major bleeding in 0.78 %. At median follow-up of 54.3 months (range 1-290), 178 (70.1 %) remain in remission. The 5-year and 10-year overall survival (OS) is 97.4 ± 1.2 % and 94.9 ± 2.1 %, respectively, while the 5-year and 10-year event-free survival (EFS) is 76.5 + 2.9 % and 71.0 + 3.9 %, respectively. Splenectomy is associated with long-term remission rates of >70 % in chronic or persistent ITP.

Clinical updates in adult immune thrombocytopenia

“…66 These data support the overall assessment that splenectomy is relatively safe, but not without risk or potential long-term complications.…”

“…65,66 Risk of infection (5-to 30-fold increase in the first 90 days and 1-to 3-fold life-long increased risk of invasive bacterial infection and sepsis), risk of thrombosis (.30-fold compared with the general population), as well as reports of pulmonary hypertension and immediate postoperative complications may have contributed to decreased splenectomy rates. Thai and colleagues examined the long-term complications of splenectomy in ITP patients in particular.…”

Immune Thrombocytopenia - Current Diagnostics and Therapy: Recommendations of a Joint Working Group of DGHO, ÖGHO, SGH, GPOH, and DGTI

“…Only 60% of patients achieve a permanent remission [107][108][109], the rest will experience a relapse of the thrombocytopenia sooner or later after splenectomy [110,111]. These numbers derive from times before the introduction of TRAs.…”

Spotlight on romiplostim in the treatment of children with chronic immune thrombocytopenia: design, development, and potential place in therapy

“…Responses are only documented in approximately one-third of patients with only occasional minor toxicities such as serum sickness and infrequent serious adverse events such as infectious complications 14,15. Surgical options including splenectomy remain as options with robust responses documented in approximately three-quarters of patients and only infrequent serious adverse events such as sepsis and major bleeding 16. These therapeutic approaches are limited and may only result in transient improvements in platelet counts and associated bleeding.…”