Long-term efficacy of partial splenic embolization for the treatment of steroid-resistant chronic immune thrombocytopenia

Abstract

Thrombopoietin-receptor agonists have been recently introduced for a second-line treatment of immune thrombocytopenia (ITP). Splenectomy has tended to be avoided because of its complications, but the response rate of splenectomy is 60-80% and it has still been considered for steroid-refractory ITP. We performed partial splenic embolization (PSE) as an alternative to splenectomy. Between 1988 and 2013, 91 patients with steroid-resistant ITP underwent PSE at our hospital, and we retrospectively analyzed the efficacy and long-term outcomes of PSE. The complete response rate (CR, platelets > 100 × 10/L) was 51% (n = 46), and the overall response rate (CR plus response (R), > 30 × 10/L) was 84% (n = 76). One year after PSE, 70% of patients remained CR and R. The group with peak platelet count after PSE ≥ 300 × 10/L (n = 29) exhibited a significantly higher platelet count than the group with platelet count < 300 × 10/L (n = 40) at any time point after PSE. The failure-free survival (FFS) rates at 1, 5, and 10 years were 78, 56, and 52%, respectively. Second PSE was performed in 20 patients who relapsed (n = 14) or had no response to the initial PSE (n = 6), and the overall response was achieved in 63% patients. There were no PSE-related deaths. These results indicate that PSE is a safe and effective alternative therapy to splenectomy for patients with steroid-resistant ITP as it generates long-term, durable responses.

Updated international consensus report on the investigation and management of primary immune thrombocytopenia

“…A retrospective single-center analysis of 91 ITP patients reported an overall response rate of 84% and a 10-year failure-free survival of 52%, concluding that partial splenic embolization generates longterm durable responses (evidence level III). 209 The most common AEs included grade 1 nausea, fever, and abdominal pain. 209 This single-center experience needs confirmation.…”

“…209 The most common AEs included grade 1 nausea, fever, and abdominal pain. 209 This single-center experience needs confirmation.…”

Combined subtotal gastrectomy and splenectomy after partial splenic embolization for a patient with gastric cancer and immune thrombocytopenic purpura: A case report

“…This procedure has been recently applied to the treatment of patients with refractory ITP as an alternative to splenectomy. Togasaki et al, reported that the median time to achieve the peak platelet count was 13 days after partial splenic embolization in their study on the efficacy of partial splenic embolization for patients with ITP [14]. Partial splenic embolization 14 days prior to surgery and high-dose immunoglobulin therapy just before operation resulted in increasing the platelet count >50,000/μL.…”

Partial Splenic Artery Embolization for the Treatment of ITP: A Case Series-Pilot Study

“…Togasaki et al who had done a study in 91 patients with steroid resistant ITP undergoing PSE found that the complete response rate (a platelet count of > 1,00,000/cumm) was found to be 51% and overall response rate was 84% (a platelet count of > 30,000/cumm). 13 Therefore, PSE could be an alternative therapy of splenectomy because it is less invasive. The cost of PSE is likely to be less than a laproscopic splenectomy.…”