Autologous platelet scintigraphy and clinical outcome of splenectomy in immune thrombocytopenia: A systematic review and meta-analysis

Amini, Sufia; Nelson, Vivianne S.; Sobels, Annemieke; Schoones, Jan W.; Zwaginga, Jaap Jan; Schipperus, Martin R.

doi:10.1016/j.critrevonc.2020.103040

Cited by 9 publications

(12 citation statements)

References 26 publications

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“… 11 To date, there is no formal predictive factor of response to splenectomy, although platelet scintigraphy can be useful, since an exclusive splenic clearance of platelets is associated with a response in 87% of the cases, compared to 47% and 25% in case of mixed or hepatic destructions. 82 …”

Section: Therapeutic Targets In Itpmentioning

confidence: 99%

Immune Thrombocytopenia: Recent Advances in Pathogenesis and Treatments

et al. 2021

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Immune thrombocytopenia (ITP) is a rare autoimmune disease due to both a peripheral destruction of platelets and an inappropriate bone marrow production. Although the primary triggering factors of ITP remain unknown, a loss of immune tolerance—mostly represented by a regulatory T-cell defect—allows T follicular helper cells to stimulate autoreactive splenic B cells that differentiate into antiplatelet antibody-producing plasma cells. Glycoprotein IIb/IIIa is the main target of antiplatelet antibodies leading to platelet phagocytosis by splenic macrophages, through interactions with Fc gamma receptors (FcγRs) and complement receptors. This allows macrophages to activate autoreactive T cells by their antigen-presenting functions. Moreover, the activation of the classical complement pathway participates to platelet opsonization and also to their destruction by complement-dependent cytotoxicity. Platelet destruction is also mediated by a FcγR-independent pathway, involving platelet desialylation that favors their binding to the Ashwell-Morell receptor and their clearance in the liver. Cytotoxic T cells also contribute to ITP pathogenesis by mediating cytotoxicity against megakaryocytes and peripheral platelets. The deficient megakaryopoiesis resulting from both the humoral and the cytotoxic immune responses is sustained by inappropriate levels of thrombopoietin, the major growth factor of megakaryocytes. The better understanding of ITP pathogenesis has provided important therapeutic advances. B cell-targeting therapies and thrombopoietin-receptor agonists (TPO-RAs) have been used for years. New emerging therapeutic strategies that inhibit FcγR signaling, the neonatal Fc receptor or the classical complement pathway, will deeply modify the management of ITP in the near future.

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Section: Therapeutic Targets In Itpmentioning

confidence: 99%

Immune Thrombocytopenia: Recent Advances in Pathogenesis and Treatments

et al. 2021

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“…A recent meta-analysis reviewed the available data about the association between post-splenectomy platelet response and sequestration pattern. 28 Remarkably, only 4 of the 23 included studies were published after 2010. 26,27,31,40 Eight studies provided data on splenectomy outcome stratified by sequestration pattern, with four of them indicating that splenic sequestration was associated with a better response after splenectomy.…”

Section: Discussionmentioning

confidence: 99%

“…19 Platelet sequestration studies, which differentiate the site of platelet destruction in patients with ITP, [20][21][22] have also been proposed as promising predictors of splenectomy outcome. [23][24][25][26][27][28] Different scanning techniques employing radiopharmaceuticals have been employed over time, with the 111 In-labelled autologous platelet scintigraphy emerging as a useful tool to determine the patients with a splenic elimination pattern who might respond better to splenectomy compared with those with a non-splenic pattern. Previous literature has explored this hypothesis without achieving consistent results, 14,15,[29][30][31] with three main groups providing recent robust data on its utility in this scenario.…”

mentioning

confidence: 99%

Study of platelet kinetics in immune thrombocytopenia to predict splenectomy response

Mendoza,

Álvarez‐Román,

Monzón‐Manzano

et al. 2023

Br J Haematol

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SummaryDespite the efficacy of splenectomy for chronic immune thrombocytopenia (ITP), its considerable failure rate and its possible related complications prove the need for further research into potential predictors of response. The platelet sequestration site determined by 111In‐labelled autologous platelet scintigraphy has been proposed to predict splenectomy outcome, but without standardisation in clinical practice. Here, we conducted a single‐centre study by analysing a cohort of splenectomised patients with ITP in whom 111In‐scintigraphy was performed at La Paz University Hospital in Madrid to evaluate the predictive value of the platelet kinetic studies. We also studied other factors that could impact the splenectomy outcome, such as patient and platelet characteristics. A total of 51 patients were splenectomised, and 82.3% responded. The splenic sequestration pattern predicted a higher rate of complete response up to 12 months after splenectomy (p = 0.005), with 90% sensitivity and 77% specificity. Neither age, comorbidities, therapy lines nor previous response to them showed any association with response. Results from the platelet characteristics analysis revealed a significant loss of sialic acid in platelets from the non‐responding patients compared with those who maintained a response (p = 0.0017). Our findings highlight the value of splenic sequestration as an independent predictor of splenectomy response.

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“…Revealing the main site of platelet sequestration can help to predict the success of splenectomy. Autologous platelet scanning can be used to detect the site of platelet sequestration, but it is technically challenging and not widely available [149]. Knowledge of desialylation capacity of the anti-platelet autoantibodies might also be helpful to detect Fc-independent clearance of platelets in the liver [22].…”

Section: Splenectomymentioning

confidence: 99%

Primary Immune Thrombocytopenia: Novel Insights into Pathophysiology and Disease Management

Singh¹,

Uzun²,

Bakchoul³

2021

JCM

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Immune thrombocytopenia (ITP) is an autoimmune disorder defined by a significantly reduced number of platelets in blood circulation. Due to low levels of platelets, ITP is associated with frequent bruising and bleeding. Current evidence suggests that low platelet counts in ITP are the result of multiple factors, including impaired thrombopoiesis and variations in immune response leading to platelet destruction during pathological conditions. Patient outcomes as well as clinic presentation of the disease have largely been shown to be case-specific, hinting towards ITP rather being a group of clinical conditions sharing common symptoms. The most frequent characteristics include dysfunction in primary haemostasis and loss of immune tolerance towards platelet as well as megakaryocyte antigens. This heterogeneity in patient population and characteristics make it challenging for the clinicians to choose appropriate therapeutic regimen. Therefore, it is vital to understand the pathomechanisms behind the disease and to consider various factors including patient age, platelet count levels, co-morbidities and patient preferences before initiating therapy. This review summarizes recent developments in the pathophysiology of ITP and provides a comprehensive overview of current therapeutic strategies as well as potential future drugs for the management of ITP.

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Autologous platelet scintigraphy and clinical outcome of splenectomy in immune thrombocytopenia: A systematic review and meta-analysis

Cited by 9 publications

References 26 publications

Immune Thrombocytopenia: Recent Advances in Pathogenesis and Treatments

Immune Thrombocytopenia: Recent Advances in Pathogenesis and Treatments

Study of platelet kinetics in immune thrombocytopenia to predict splenectomy response

Primary Immune Thrombocytopenia: Novel Insights into Pathophysiology and Disease Management

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