Splenectomy outcomes in immune cytopenias: Treatment outcomes and determinants of response

Abstract

BackgroundSplenectomy is commonly used to treat refractory immune–mediated cytopenia, but there are no established factors that are associated with response to the procedure.ObjectivesA cohort study was conducted to evaluate the hematologic and surgical outcomes of splenectomy in adult patients with immune cytopenias and identify preoperative factors associated with response.MethodsData from the Cleveland Clinic Foundation for 1824 patients aged over 18 who underwent splenectomy from 2002 to 2020 were analyzed.ResultsThe study found that the most common indications for splenectomy were immune thrombocytopenic purpura (ITP) and autoimmune hemolytic anemia, with a median age of 55 years and median time from diagnosis to splenectomy of 11 months. Hematologic response rates were 74% overall, with relapse in 12% of cases. Postsplenectomy discordant diagnoses were present in 13% of patients, associated with higher relapse rates. Surgery‐related complications occurred in 12% of cases, whereas only 3% of patients died from disease complications. On univariate analysis, preoperative factors associated with splenectomy treatment failure were ≥3 lines of pharmacologic treatment, whereas isolated thrombocytopenia, primary ITP, and age ≤40 years had a strong association with response. The multivariable regression confirmed that treatment failure with multiple lines of medical therapy was associated with the failure to respond to splenectomy.ConclusionOverall, the study demonstrates that splenectomy is an effective treatment option for immune‐mediated cytopenias with a low complication rate.

Autoimmune Hemolytic Anemias: Classifications, Pathophysiology, Diagnoses and Management

“…Although splenectomy was used for years with immense success, it is rarely used today [3,60]. In a recent cohort study of 1824 patients, splenectomy was found to be an effective treatment, though with surgical complications in 12% [69].…”

“…Cold-antibody autoimmune hemolytic anemia, referred to as cold agglutinin syndrome (CAS) or cold agglutinin disease (CAD), is a rare autoimmune condition characterized by the presence of high levels of cold-sensitive autoantibodies in the blood, primarily IgM, as well as autoantibodies that remain active at temperatures below 30 • C (86 • F) [3,12,20,[70][71][72][73][74][75][76]. The antibodies have a particular affinity for red blood cells, often the Ii RBC antigens [3,12,77,78], causing them to aggregate (agglutination), activate the complement system, and undergo intra-and/or extravascular hemolysis [3,12,20,[67][68][69][70][71][72][73][74][75][76][77]. Historically, CAD included both CAD and CAS; however, these two conditions are now recognized as different and have been separated into distinct entities.…”

Autoimmune Hemolytic Anemias

“…Although splenectomy was used for years with immense success, it is rarely used today [3,60]. In a recent cohort study of 1824 patients, splenectomy was found to be an effective treatment, though with surgical complications in 12% [69].…”

Splenectomy reappraised: Bridging the gap in immune cytopenia treatment paradigms

“…It is in this context of the absence of planned prospective data collection in this arena that, in this issue of the Journal of Internal Medicine, Ogbue et al provide crucial insights of their institutional experience with splenectomy in the treatment of patients with a variety of autoimmune cytopenias at the Cleveland Clinic, an institution in the United States with a deep commitment to clinical excellence [9]. The authors meticulously applied thoughtful exclusion criteria through a retrospective evaluation of 1824 consecutive splenectomy cases across the years 2002-2020 to properly isolate 339 patients who underwent splenectomy for one of the following autoimmune pathology-proven discordant diagnoses appropriately removed from effectiveness metrics (Fig.…”