Splenectomy outcomes in patients with autoimmune cytopenias and persistent antiphospholipid antibodies

Abstract

Background Splenectomy is a therapy for patients with treatment‐refractory autoimmune cytopenias. Antiphospholipid antibodies (aPL) can be identified in 25%–85% of these patients. In this study, we sought to identify whether the presence of aPL was associated with worse outcomes in autoimmune cytopenia's patients who had undergone splenectomy. Methods We conducted a retrospective cohort study of patients who underwent splenectomy from 2000 to 2018. We describe clinical characteristics and outcomes in patients with autoimmune cytopenia's diagnosis with positive determinations of aPL. Additionally, we performed a case–control sub‐analysis 1:1 of the cases with autoimmune cytopenia's matched control patients with negative aPL determination. Results A splenectomy was performed in 707 patients, of which we included 34 for the analysis. The median age at the time of splenectomy was 37 years (range 19–61), 53% corresponded to immune thrombocytopenia (ITP) and 47% to autoimmune hemolytic anemia (AIHA). Compared with controls (n = 34), patients had more treatment lines in addition to steroids (p = .02). There were no differences in complete response rate, 65% in cases and 80% in controls (p = .17). However, there was numerically a higher incidence of early infections (21% of cases vs. 3% controls, p = .05). During the entire follow‐up, 15% of aPL patients compared with 9% of control patients had a thrombotic event (p = .70). Discussion Splenectomy for treatment‐refractory autoimmune cytopenia's patients with persistent aPL is an effective treatment despite some safety concerns related to early infections. These results suggest that the presence of aPL should not impact the decision to undergo splenectomy.

Is splenectomy a good strategy for refractory immune thrombocytopenia in adults?

“…Similarly, in a recent study of patients with anti-phospholipid syndrome or autoimmune cytopenia associated with triple positivity of anti-phospholipid antibodies, the authors did not note any increased risk of thrombosis as compared to patients who had splenectomy with the absence of anti-phospholipid antibodies and a median follow-up of 48 months. 56 These encouraging results were not confirmed in a recent series of 19 patients who had splenectomy. 57 DVT or arterial thrombosis occurred in six patients: four had the absence of anti-phospholipid antibodies, one patient with failure of splenectomy received TPO-RAs and had triple positive anti-phospholipid antibodies, and one patient experienced a thrombotic event after an IVIg infusion.…”

“…In our experience 54 and that of Delgado Alves et al, 55 we have not found increased risk of thrombosis. Similarly, in a recent study of patients with anti‐phospholipid syndrome or autoimmune cytopenia associated with triple positivity of anti‐phospholipid antibodies, the authors did not note any increased risk of thrombosis as compared to patients who had splenectomy with the absence of anti‐phospholipid antibodies and a median follow‐up of 48 months 56 . These encouraging results were not confirmed in a recent series of 19 patients who had splenectomy 57 .…”