Predictive value of response to steroid therapy on response to splenectomy in children with immune thrombocytopenic purpura

Hollander, Lindsay; Leys, Charles M.; Weil, Brent R.; Rescorla, Frederick J.

doi:10.1016/j.surg.2011.07.063

Cited by 7 publications

(3 citation statements)

References 9 publications

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“…Thrombosis, which has occurred in adults receiving TPO-RAs, was not seen in children. 82,[147][148][149][150][151]162 ), 13 studies reported on durable response (3 rituximab arm, [143][144][145] 10 splenectomy arm 82,[151][152][153][154][155][156][157][158][159] ), 7 studies reported on remission (1 rituximab arm, 144 6 splenectomy arm 147,150,151,155,160,161 ), 8 studies reported on major bleeding (1 rituximab arm, 144 7 splenectomy arm [149][150][151]154,156,158,159 ), 12 studies reported on infections (3 rituximab arm, 142-144 9 splenectomy arm 84,147,[150][151][152][154][155][156]162 ), 3 studies reported on operative complications (3 splenectomy arm 147,151,…”

Section: Recommendation 15mentioning

confidence: 99%

American Society of Hematology 2019 guidelines for immune thrombocytopenia

et al. 2019

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Background: Despite an increase in the number of therapies available to treat patients with immune thrombocytopenia (ITP), there are minimal data from randomized trials to assist physicians with the management of patients. Objective: These evidence-based guidelines of the American Society of Hematology (ASH) are intended to support patients, clinicians, and other health care professionals in their decisions about the management of ITP. Methods: In 2015, ASH formed a multidisciplinary guideline panel that included 8 adult clinical experts, 5 pediatric clinical experts, 2 methodologists with expertise in ITP, and 2 patient representatives. The panel was balanced to minimize potential bias from conflicts of interest. The panel reviewed the ASH 2011 guideline recommendations and prioritized questions. The panel used the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach, including evidence-to-decision frameworks, to appraise evidence (up to May 2017) and formulate recommendations. Results: The panel agreed on 21 recommendations covering management of ITP in adults and children with newly diagnosed, persistent, and chronic disease refractory to first-line therapy who have non–life-threatening bleeding. Management approaches included: observation, corticosteroids, IV immunoglobulin, anti-D immunoglobulin, rituximab, splenectomy, and thrombopoietin receptor agonists. Conclusions: There was a lack of evidence to support strong recommendations for various management approaches. In general, strategies that avoided medication side effects were favored. A large focus was placed on shared decision-making, especially with regard to second-line therapy. Future research should apply standard corticosteroid-dosing regimens, report patient-reported outcomes, and include cost-analysis evaluations.

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Section: Recommendation 15mentioning

confidence: 99%

American Society of Hematology 2019 guidelines for immune thrombocytopenia

et al. 2019

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“…The surgery was successful in 75% of the eight patients who did not have any response to corticosteroid therapy. These findings suggest that there is no correlation between previous response to corticosteroids and response to splenectomy (26) (B).…”

Section: What Is the Role Of Splenectomy In The Treatment Of Primary mentioning

confidence: 96%

“…There was no association between the patients' response to IVIg, anti-D or rituximab and response to splenectomy (p-value = 0.24). There was a correlation between corticosteroid response and the response to splenectomy (26) (B).…”

Section: Is There Evidence Of Predictive Clinical or Laboratory Critementioning

confidence: 99%