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

Godeau, Bertrand

doi:10.1111/bjh.19077

Cited by 6 publications

(1 citation statement)

References 65 publications

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“…Smaller studies have analyzed responses to prior medical therapy such as steroids [28] and IVIG [29][30][31] with conflicting results. A recent analysis showed variability in real-life practice [32], and as such, there is currently no definitive consensus regarding the influence of medical treatment response on the decision to undergo splenectomy [33].…”

Section: Discussionmentioning

confidence: 99%

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

Ogbue,

Bahaj,

Kewan

et al. 2023

J Intern Med

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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.

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Section: Discussionmentioning

confidence: 99%

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

Ogbue,

Bahaj,

Kewan

et al. 2023

J Intern Med

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Pediatric refractory chronic immune thrombocytopenia: Identification, patients' characteristics, and outcome

Pincez,

Fernandes,

Fahd

et al. 2024

American J Hematol

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Refractory chronic immune thrombocytopenia (r‐cITP) is one of the most challenging situations in chronic immune thrombocytopenia (cITP). Pediatric r‐cITP is inconsistently defined in literature, contributing to the scarcity of data. Moreover, no evidence is available to guide the choice of treatment. We compared seven definitions of r‐cITP including five pediatric definitions in 886 patients with cITP (median [min‐max] follow‐up 5.3 [1.0–29.3] years). The pediatric definitions identified overlapping groups of various sizes (4%–20%) but with similar characteristics (higher proportion of immunopathological manifestations [IM] and systemic lupus erythematosus [SLE]), suggesting that they adequately captured the population of interest. Based on the 79 patients with r‐cITP (median follow‐up 3.1 [0–18.2] years) according to the CEREVANCE definition (≥3 second‐line treatments), we showed that r‐cITP occurred at a rate of 1.15% new patients per year and did not plateau over time. In multivariate analysis, older age was associated with r‐cITP. One patient (1%) experienced two grade five bleeding events after meeting r‐cITP criteria and while not receiving second‐line treatment. The cumulative incidence of continuous complete remission (CCR) at 2 years after r‐cITP diagnosis was 9%. In this analysis, splenectomy was associated with a higher cumulative incidence of CCR (hazard ratio: 5.43, 95% confidence interval: 1.48–19.84, p = 7.8 × 10−4). In sum, children with cITP may be diagnosed with r‐cITP at any time point of the follow‐up and are at increased risk of IM and SLE. Second‐line treatments seem to be effective for preventing grade 5 bleeding. Splenectomy may be considered to achieve CCR.

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Elective splenectomy for hematological diseases: a vanishing indication

Fernández-Ananin,

Novelli,

Cambeiro Cabré

et al. 2024

Surg Endosc

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Introduction Splenectomy has been used as a diagnostic and therapeutic tool in the management of hematological diseases for many years. However, the emergence of new medical therapies has modified guidelines for many hematological diseases for which splenectomy was previously considered. We aimed to evaluate the evidence of a decrease in the hematological indications for splenectomy and the reasons and justifications for this change. Material and methods We conducted a single-center, retrospective analysis of patients who underwent laparoscopic splenectomy for hematological disease between January 2010 and December 2023. Patients were classified into four groups: 1 autoimmune and hemolytic diseases (HAD), (2) lymphomas, (3) myeloproliferative diseases (MPN), and (4) other splenic diseases. We recorded the annual incidence of splenectomy and the ratio of new medical cases, demographic and clinical data and surgical outcomes. Results During the study period, 98 patients were referred for splenectomy. There was a significant progressive decrease in this surgical indication, particularly regarding HAD (p < 0.001). The indication for splenectomy for immune thrombocytopenic purpura (ITP) declined to zero despite an increase in the number of patients diagnosed with this disorder (p < 0.001). The pattern of decrease in AHAI and Evans syndrome was similar to that in ITP. The group of splenectomies due to lymphoma persisted consistently during the study period, as did the indication for splenectomy in the context of lymphoma treatment. Splenectomy due to massive splenomegaly secondary to MPN was indicated only in one patient. Splenectomies due to other causes were similarly distributed over the years. Conclusions Our findings confirm a significant decrease in the indication for elective surgery for hematological diseases, mainly regarding autoimmune disease. The surgical community and surgical departments should be aware of this situation yet maintain the skills to adopt this technique both safely and efficiently.

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

Cited by 6 publications

References 65 publications

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

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

Pediatric refractory chronic immune thrombocytopenia: Identification, patients' characteristics, and outcome

Elective splenectomy for hematological diseases: a vanishing indication

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