Response to splenectomy is durable after a certain point in time in adult patients with chronic immune thrombocytopenic purpura

Abstract

Splenectomy may lead to a good response in 60-80% of adult patients with corticosteroid refractory idiopathic thrombocytopenic purpura (ITP) but, the long-term response to splenectomy still remains less well defined. We assessed the long-term efficacy and safety of splenectomy in adult patients with chronic ITP. A cohort of 59 splenectomised ITP patients (M/F = 25/34; median age 39 yr; range 14-75) were followed up for a median of 18 yr (range 2-32). No life-threatening surgical complications were observed. The overall response rate was 78% with 59% complete remission (CR) and 19% partial remission (PR). CR and PR patients were younger than non-responding patients at time of diagnosis (median age: 36 yr vs 48 yr, P = 0.03) and at splenectomy (median age: 38 yr vs 51 yr, P = 0.02). Among the 46 responding patients, eventually 17 had relapse. No disease progression occurred after 12.1 and 7.3 yr for patients in CR or PR, respectively. One case of fatal septicaemia was recorded. We conclude that splenectomy is an effective and safe treatment in adult patients with chronic ITP failing to respond to corticosteroid treatment and importantly, our findings support the view that response to splenectomy is durable after a certain point in time.

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

“…Despite the fact that time-honored data consistently show that splenectomy is able to induce a stable response in a substantial fraction of patients, 17,18,20 the recent availability of new second-line drugs, such as rituximab or TPO mimetics, has offered the possibility of a medical treatment not burdened by surgery-related early and late complications. For this reason, both patients and physicians are increasingly reluctant to proceed to splenec-haematologica | 2013; 98(6) Relapse-free survival tomy as second-line therapy, and there is still lively international debate on the therapeutic algorithm of patients failing first-line corticosteroid treatment.…”

“…One hundred and twenty-nine out of 233 (55%) of these patients were previously reported in two different papers describing two separate experiences: one collected in a single-center Swedish study of 61 ITP patients (48 patients, 78%), 17 and one in a multi-center Italian study of 402 patients (81 patients, 20%). 18 These cases were included in the present report after a significant lengthening of their observation time; moreover, some centers participating in the 2005 GIMEMA study were different to those included in the present report.…”

Rituximab efficacy and safety in adult splenectomy candidates with chronic immune thrombocytopenic purpura: results of a prospective multicenter phase 2 study

“…Our objective was not to compare rituximab to splenectomy, because the expected response rate after splenectomy (ϳ 65%) 6 would surely be higher than that of rituximab. However, splenectomy may be associated with immediate morbidity and a long-term and unpredictable risk of fatal overwhelming sepsis, [11][12][13] and it has also been emphasized that the risk of long-term relapse after splenectomy has been underestimated. 14,15 Therefore, finding a safe alternative therapeutic option to splenectomy that could induce a long-term remission is still an unmet need for patients with severe chronic ITP.…”

“…9,10 In addition, the risk of overwhelming postsplenectomy infections, although rare, is not predictable and represents a major concern. [11][12][13] Moreover, some authors reported that, despite initial good responses to splenectomy, the risk of late relapse persists during long-term follow-up 14,15 and severe morbidity resulting from surgery is associated with 11% to 30% postoperative complications requiring prolonged hospitalization or readmission. 11,16 For these reasons, an effective and safe alternative to splenectomy would improve management of chronic ITP.…”

Relapse of Immune Thrombocytopenia Associated with Varicella 20 Years after Splenectomy

“…While splenectomy is effective in increasing the platelet count in approximately 80% of patients (1), no preoperative factors can be used to identify patients likely to respond to splenectomy (4,5,16,17). In addition, approximately 20% of responders to splenectomy subsequently relapse (3)(4)(5)(16)(17)(18)(19). Most episodes of relapse occur within two years after splenectomy (5), with a plateau in the remission curve after 12 years reported in one study (19), although some patients relapse after a prolonged period (5,6,17,19).…”