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Long-term outcome following splenectomy for chronic and persistent immune thrombocytopenia (ITP) in adults and children

Splenectomy in ITP

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Abstract

The purpose of this research is to study the outcomes of splenectomy for chronic and persistent immune thrombocytopenia (ITP). This study is a retrospective analysis of 254 patients with chronic or persistent ITP who underwent splenectomy at CMC, Vellore, India between 1995 and 2009. Responses were assessed based on standard criteria. One hundred and sixty seven adults and 87 children with a median age of 29 years (range 2–64) with persistent (n = 103) or chronic ITP (n = 151) was studied. Response was seen in 229 (90.2 %) including CR in 74.4 % at a median time of 1 day (range 1–54). Infections following splenectomy were reported in 16 %. Deaths related to post splenectomy sepsis occurred in 1.57 % and major bleeding in 0.78 %. At median follow-up of 54.3 months (range 1–290), 178 (70.1 %) remain in remission. The 5-year and 10-year overall survival (OS) is 97.4 ± 1.2 % and 94.9 ± 2.1 %, respectively, while the 5-year and 10-year event-free survival (EFS) is 76.5 + 2.9 % and 71.0 + 3.9 %, respectively. Splenectomy is associated with long-term remission rates of >70 % in chronic or persistent ITP.

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References

  1. Cines DB, Blanchette VS (2002) Immune thrombocytopenic purpura. N Engl J Med 346(13):995–1008

    Article  PubMed  Google Scholar 

  2. Neunert C, Lim W, Crowther M et al (2011) The American Society of Hematology 2011 evidence-based practice guideline for immune thrombocytopenia. Blood 117(16):4190–207

    Article  CAS  PubMed  Google Scholar 

  3. Berchtold P, McMillan R (1989) Therapy of chronic idiopathic thrombocytopenic purpura in adults. Blood 74(7):2309–17

    CAS  PubMed  Google Scholar 

  4. Gibson M, Sehon JK, White S et al (2000) Splenectomy for idiopathic thrombocytopenic purpura: a five-year retrospective review. Am Surg 66(10):952–4

    CAS  PubMed  Google Scholar 

  5. Ben-Yehuda D, Gillis S, Eldor A (1994) Clinical and therapeutic experience in 712 Israeli patients with idiopathic thrombocytopenic purpura. Israeli ITP Study Group. Acta Haematol 91(1):1–6

    Article  CAS  PubMed  Google Scholar 

  6. Katkhouda N, Hurwitz MB, Rivera RT et al (1998) Laparoscopic splenectomy: outcome and efficacy in 103 consecutive patients. Ann Surg 228(4):568–78

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  7. Louwes H, Vellenga E, Houwerzijl EJ, de Wolf JT (2001) Effects of prednisone and splenectomy in patients with idiopathic thrombocytopenic purpura: only splenectomy induces a complete remission. Ann Hematol 80(12):728–32

    Article  CAS  PubMed  Google Scholar 

  8. Pizzuto J, Ambriz R (1984) Therapeutic experience on 934 adults with idiopathic thrombocytopenic purpura: multicentric trial of the cooperative Latin American group on hemostasis and thrombosis. Blood 64(6):1179–83

    CAS  PubMed  Google Scholar 

  9. Rodeghiero F, Stasi R, Gernsheimer T et al (2009) Standardization of terminology, definitions and outcome criteria in immune thrombocytopenic purpura of adults and children: report from an international working group. Blood 113(11):2386–93

    Article  CAS  PubMed  Google Scholar 

  10. Kumar S, Diehn FE, Gertz MA, Tefferi A (2002) Splenectomy for immune thrombocytopenic purpura: long-term results and treatment of postsplenectomy relapses. Annals Haematol 81(6):312–9

    Article  CAS  Google Scholar 

  11. Fabris F, Tassan T, Ramon R et al (2001) Age as the major predictive factor of long-term response to splenectomy in immune thrombocytopenic purpura. Br J Haematol 112(3):637–40

    Article  CAS  PubMed  Google Scholar 

  12. Winde G, Schmid KW, Lugering N et al (1996) Results and prognostic factors of splenectomy in idiopathic thrombocytopenic purpura. J Am Coll Surg 183(6):565–74

    CAS  PubMed  Google Scholar 

  13. Aleem A (2011) Durability and factors associated with long term response after splenectomy for primary immune thrombocytopenia (ITP) and outcome of relapsed or refractory patients. Platelets 22(1):1–7

    Article  CAS  PubMed  Google Scholar 

  14. Kojouri K, Vesely SK, Terrell DR, George JN (2004) Splenectomy for adult patients with idiopathic thrombocytopenic purpura: a systematic review to assess long-term platelet count responses, prediction of response, and surgical complications. Blood 104(9):2623–34

    Article  CAS  PubMed  Google Scholar 

  15. Shojaiefard A, Mousavi SA, Faghihi SH, Abdollahzade S (2008) Prediction of response to splenectomy in patients with idiopathic thrombocytopenic purpura. World J Surg 32(3):488–93

    Article  CAS  PubMed  Google Scholar 

  16. Fenaux P, Caulier MT, Hirschauer MC et al (1989) Reevaluation of the prognostic factors for splenectomy in chronic idiopathic thrombocytopenic purpura (ITP): a report on 181 cases. Eur J Haematol 42(3):259–64

    Article  CAS  PubMed  Google Scholar 

  17. Bourgeois E, Caulier MT, Delarozee C et al (2003) Long-term follow-up of chronic autoimmune thrombocytopenic purpura refractory to splenectomy: a prospective analysis. Br J Haematol 120(6):1079–88

    Article  PubMed  Google Scholar 

  18. Erh-Hao L, Chakravarty DK, Ta-Sen Y et al (2013) Long-term relapse free survival rate and predictive factors of idiopathic thrombocytopenic purpura in adults undergoing splenectomy. Biomed J 36:23–27

    Article  Google Scholar 

  19. Qu Y, Xu J, Jiao C, Cheng Z, Ren S (2014) Long-term outcomes of laparoscopic splenectomy versus open splenectomy for idiopathic thrombocytopenic purpura. Int Surg 99(3):286–90

    Article  PubMed  PubMed Central  Google Scholar 

  20. Vecchio R, Marchese S, Intagliata E et al (2013) Long term results after splenectomy in adult idiopathic thrombocytopenic purpura: comparison between open and laparoscopic procedures. J Laparoendosc Adv Surg Tech 23(3):192–8

    Article  Google Scholar 

  21. Vianelli N, Palandri F, Polverelli N (2013) Splenectomyasa curative treatment for immune thrombocytopenia:a retrospective analysis of 233 patients with a minimum follow up of 10 years. Haematologica 98(6):875–880

    Article  PubMed  PubMed Central  Google Scholar 

  22. Schwartz J, Leber MD, Gillis S et al (2003) Long term follow-up after splenectomy performed for immune thrombocytopenic purpura (ITP). Am J Hematol 72(2):94–8

    Article  PubMed  Google Scholar 

  23. Vianelli N, Galli M, de Vivo A, Intermesoli T et al (2005) Efficacy and safety of splenectomy in immune thrombocytopenic purpura: long-term results of 402 cases. Haematologica 90(1):72–7

    PubMed  Google Scholar 

  24. Thompson RL, Moore RA, Hess CE et al (1972) Idiopathic thrombocytopenic purpura. Long-term results of treatment and the prognostic significance of response to corticosteroids. Arch Intern Med 130(5):730–4

    Article  CAS  PubMed  Google Scholar 

  25. Moulis G, Sailler L, Sommet A et al (2014) Rituximab versus splenectomy in persistent or chronic adult primary immune thrombocytopenia; an adjusted comparison of mortality and morbidity. Am J Hematol 89:41–46

    Article  CAS  PubMed  Google Scholar 

  26. Ghanima W, Godeau B, Cines DB, Bussel JB (2012) How I treat immune thrombocytopenia: the choice between splenectomy or a medical therapy as a second-line treatment. Blood 120(5):960–969

    Article  CAS  PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of Haematology, Rajiv Gandhi Cancer Institute & Research Centre, New Delhi, India

    Rayaz Ahmed

  2. Department of Haematology, Christian Medical College, Vellore, Tamil Nadu, India

    Anup J. Devasia, Auro Viswabandya, Kavitha M. Lakshmi, Aby Abraham, Alok Srivastava, Vikram Mathews & Biju George

  3. Department of Paediatric Surgery, Christian Medical College, Vellore, Tamil Nadu, India

    Sampath Karl & John Mathai

  4. Department of General Surgery, Christian Medical College, Vellore, Tamil Nadu, India

    Paul M. Jacob & Deepak Abraham

Authors
  1. Rayaz Ahmed
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  2. Anup J. Devasia
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  3. Auro Viswabandya
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  4. Kavitha M. Lakshmi
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  5. Aby Abraham
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  12. Biju George
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Corresponding author

Correspondence to Biju George.

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This study was approved by the local institutional review board.

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Ahmed, R., Devasia, A.J., Viswabandya, A. et al. Long-term outcome following splenectomy for chronic and persistent immune thrombocytopenia (ITP) in adults and children. Ann Hematol 95, 1429–1434 (2016). https://doi.org/10.1007/s00277-016-2738-3

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  • DOI: https://doi.org/10.1007/s00277-016-2738-3

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