Prognostic Factors for Splenectomy Response in Adult Idiopathic Thrombocytopenic Purpura

Rocco, M.; Rs, Stein

doi:10.1097/00007611-198408000-00012

Cited by 14 publications

(7 citation statements)

References 0 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…In the present study, an initial CR after steroid treatment was significantly associated with the subsequent CR after splenectomy. Similar prognostic correlation has been reported [7], although a more recent study failed to show a significant association [4].…”

Section: Discussionsupporting

confidence: 76%

Clinicopathologic and prognostic features of chronic idiopathic thrombocytopenic purpura in adult Chinese patients: an analysis of 220 cases

et al. 2001

View full text Add to dashboard Cite

To determine the clinicopathologic and prognostic features of chronic idiopathic thrombocytopenic purpura (ITP) in adult Chinese patients, we conducted a retrospective analysis of 220 patients seen at a single center over a 40-year period. The female-to-male ratio was 4:1, with a mean age of 42.1 +/- 1.3 years, a mean platelet count of 33.7 +/- 2.3x10(9)/l, and a mean follow-up of 116 +/- 7 months. Initial steroid treatment was required in 142 patients, 67 of whom (47.2%) achieved complete remission (CR). At 470 months, 46% patients remained in CR. Splenectomy was performed in 37 patients: in 23 patients due to primary steroid refractoriness and in 7 patients due to disease relapse following initial CR with steroids. In seven patients, data on response to steroids prior to splenectomy were not available. Splenectomy for steroid nonresponders resulted in an inferior CR rate (13 of 23, 56%) as compared with that for relapses after steroid treatment (7 of 7, 100%) (P<0.05). Compared with patients with negative antinuclear antibody (ANA), those who were ANA positive had similar responses to steroids, but significantly shorter remission after splenectomy (P<0.01). In conclusion, Chinese patients with ITP could maintain long-term remission after steroid therapy and splenectomy. In addition, primary steroid refractoriness and positive ANA were bad prognostic factors of the subsequent response to splenectomy.

show abstract

Section: Discussionsupporting

confidence: 76%

Clinicopathologic and prognostic features of chronic idiopathic thrombocytopenic purpura in adult Chinese patients: an analysis of 220 cases

et al. 2001

View full text Add to dashboard Cite

show abstract

“…Several teams have attempted to identify prognostic factors for the response to splenectomy in patients with chronic AITP. Some claimed that a favourable outcome after surgery was more likely in younger patients, those with an initial response to steroids, and those with a shorter interval between diagnosis and splenectomy (Den Ottolander et al , 1984; Rocco & Stein, 1984; Naouri et al , 1993). Like Fenaux et al (1989), we failed to confirm these results.…”

Section: Discussionmentioning

confidence: 99%

The response to high‐dose intravenous immunoglobulin or steroids is not predictive of outcome after splenectomy in adults with autoimmune thrombocytopenic purpura

Ruivard¹,

Caulier

Vantelon³

et al. 1999

Br J Haematol

View full text Add to dashboard Cite

Summary. The response to high-dose intravenous immunoglobulin (IVIg) was recently reported to be predictive of outcome after splenectomy in patients with autoimmune thrombocytopenic purpura (AITP). We analysed the records of 75 adults with chronic AITP who received IVIg and subsequently underwent splenectomy. There was no significant difference in the response rate to splenectomy according to whether or not patients had responded to IVIg (81% v 67%, P ¼ 0·36). Age, the time from diagnosis to splenectomy, and the response to steroids were also not significantly associated with outcome after splenectomy. These results indicate that the response to IVIg or steroids is not predictive of the efficacy of splenectomy.Keywords: autoimmune thrombocytopenic purpura, splenectomy, intravenous immunoglobulins.Although alternatives have been proposed, splenectomy remains the best treatment for patients with chronic autoimmune thrombocytopenic purpura (AITP) (Blanchette et al, 1998). However, only 50-90% of patients respond to splenectomy, and 10% relapse after initial success (Karpatkin, 1997). Moreover, even if the operative mortality rate is now probably low, morbidity can be severe, particularly in older patients who, furthermore, do not respond to splenectomy as well as younger subjects (George et al, 1996). Splenectomized patients are also more at risk of life-threatening infections. Thus, it would be useful to have a means of predicting the response to splenectomy. Recently, Law et al (1997) found a close relationship between the platelet increase after high-dose intravenous immunoglobulin (IVIg) and the outcome of splenectomy. We sought to confirm these findings and evaluate the value of some other preoperative criteria in a larger series of adults with chronic AITP. PATIENTS AND METHODSAll adults (age >17 years) with AITP followed in three centres who received IVIg and subsequently underwent splenectomy were included. AITP was diagnosed according to standard criteria, i.e. isolated thrombocytopenia, normal or increased megakaryocyte count in an otherwise normal bone marrow aspirate, and absence of other causes of thrombocytopenia. Patients with human immunodeficiency virus infection or systemic lupus erythematosus were excluded. Responses to IVIg, steroids and splenectomy were analysed; a positive response was defined as a platelet count increase to > 50 × 10 9 /l and at least twice the initial value. A response to splenectomy was recorded only if no relapses occurred (in such situations an accessory spleen was not found despite systematic search). Different IVIg treatment schedules were administered: one group of patients received a total IVIg dose of 2 g/kg body weight (b.w.) injected over 2-5 d, and another group received 0·5-1 g/kg b.w. infused in 1 d. In this latter group, IVIg was always reinfused if no platelet response was observed on day 3; thus, all non-responders received a total IVIg dose of 2 g/kg b.w. The response to steroids was assessable in 62 patients; the administered dose of steroids ranged from 1 ...

show abstract

“…Twelve of the 17 studies reported the anatomic site of bleeding. 4,13,[15][16][17]19,21,[24][25][26][27][28] Among these studies, 31 of the fatal bleeding events were intracranial and 8 were at other sites; thus, the proportion of central nervous system bleeding events among fatal bleeding events was 31 of 39 (0.79). Nine of the 17 included studies that reported the age distribution of their cohorts 4,9,10,[12][13][14]17,19,24 : these studies included 34 of the 49 fatalities.…”

Section: Risk For Disabling Hemorrhagic Strokementioning

confidence: 99%

The Bleeding Risk and Natural History of Idiopathic Thrombocytopenic Purpura in Patients With Persistent Low Platelet Counts

Djulbegoviĉ²,

et al. 2000

View full text Add to dashboard Cite

show abstract

Prognostic Factors for Splenectomy Response in Adult Idiopathic Thrombocytopenic Purpura

Cited by 14 publications

References 0 publications

Clinicopathologic and prognostic features of chronic idiopathic thrombocytopenic purpura in adult Chinese patients: an analysis of 220 cases

Clinicopathologic and prognostic features of chronic idiopathic thrombocytopenic purpura in adult Chinese patients: an analysis of 220 cases

The response to high‐dose intravenous immunoglobulin or steroids is not predictive of outcome after splenectomy in adults with autoimmune thrombocytopenic purpura

The Bleeding Risk and Natural History of Idiopathic Thrombocytopenic Purpura in Patients With Persistent Low Platelet Counts

Contact Info

Product

Resources

About