Long-term Relapse-free Rurvival Rate and Predictive Factors of Idiopathic Thrombocytopenic Purpura in Adults Undergoing Splenectomy

Liu, Erh-Hao; Dilip, C; Yeh, Ta‐Sen; Wu, Jin‐Hou; Jan, Yi-Yin; Chen, Miin‐Fu

doi:10.4103/2319-4170.107158

Cited by 9 publications

(5 citation statements)

References 30 publications

(49 reference statements)

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“…A similar correlation was reported by Ojima et al [27], who showed that a high platelet count on POD 7 correlated with a good response to splenectomy. In another study of 54 patients who underwent splenectomy, the postoperative platelet count was also a significant predictive factor of response [28]. Although some studies failed to show postoperative platelet counts as a predictive marker of response for splenectomy [21,31,32], it could be a useful tool to predict the response to splenectomy easily and immediately.…”

Section: Discussionmentioning

confidence: 99%

“…Several studies have sought to identify preoperative or postoperative variables predicting a successful outcome following splenectomy, including age, preoperative platelet count, megakaryocyte hyperplasia, site of platelet sequestration, and postoperative platelet count [8,10,12,13,19,21,22,27,28,29,30]. However, until now, there has been no widely accepted and reliable test predicting the response to splenectomy.…”

Section: Discussionmentioning

confidence: 99%

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Clinical Outcome and Predictive Factors in the Response to Splenectomy in Elderly Patients with Primary Immune Thrombocytopenia: A Multicenter Retrospective Study

Park

Kim

et al. 2016

Acta Haematol

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Background: Because many physicians seem reluctant to recommend splenectomy for elderly patients with immune thrombocytopenia (ITP), we investigated the safety and efficacy of splenectomy and the predictive factors for response in these patients. Methods: 184 patients with primary ITP were retrospectively analyzed based on age at splenectomy: an elderly group (≥60 years, n = 52) and a younger group (<60 years, n = 132). Results: There was no difference in the response rate of elderly versus younger patients (80.7 vs. 80.3%, p = 0.466). Relapse (45.2 vs. 22.6%, p = 0.006), complications, and median postoperative stay (9.5 vs. 7 days, p = 0.019) were significantly higher in the elderly group. The 5-year relapse-free survival of responders was 51.8% in the elderly group and 76.3% in the younger group (p = 0.002). Response to any treatment before splenectomy (HR 2.9, 95% CI: 1.24-6.80, p = 0.014) and platelet count on postoperative day 14 ≥200 × 10⁹/l (HR 31.43, 95% CI: 4.15-238.28, p = 0.001) were independent factors for a favorable response. Conclusions: Age ≥60 years did not influence the response to splenectomy but was associated with increased relapse and postoperative complications. Splenectomy could provide a durable long-term response for elderly ITP patients.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Clinical Outcome and Predictive Factors in the Response to Splenectomy in Elderly Patients with Primary Immune Thrombocytopenia: A Multicenter Retrospective Study

Park

Kim

et al. 2016

Acta Haematol

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“…Several clinical and laboratory factors have been raised to predict the outcome of ITP patients undergoing splenectomy. In general, a young age, a short disease duration of ITP, and a prior response to steroids are associated with a better response to splenectomy [1, 6, 22-24]. Indium-labeled platelet scintigraphy has been shown to predict the response to splenectomy by showing the site of platelet trapping or clearance [25, 26].…”

Section: Discussionmentioning

confidence: 99%

“…Both preoperative and postoperative platelet counts were reported to be associated with treatment response [5, 6, 30-32]. It appears that a higher baseline platelet count (i.e., before preoperative measures to increase the platelet count) has a trend of association with a higher rate of CR and a sustained CR.…”

Section: Discussionmentioning

confidence: 99%

“…Despite emerging novel treatment modalities for immune thrombocytopenia (ITP), splenectomy remains important for the management of relapsed and refractory ITP [1-4]. The efficacy and potential complications of splenectomy can be accurately predicted by some preoperative conditions, including platelet count [5, 6]. Laparoscopic splenectomy (LS) has replaced open splenectomy (OS) as the standard approach in recent years.…”

Section: Introductionmentioning

confidence: 99%

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Impact of Platelet Counts, Surgical Methods, and Preoperative Platelet Transfusion on the Outcome of Splenectomy for Immune Thrombocytopenia

et al. 2020

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Introduction: Splenectomy is an important and potentially curative treatment for immune thrombocytopenia (ITP). Laparoscopic splenectomy (LS) has replaced open splenectomy (OS) as the standard approach. The prognostic role of platelet count and the clinical indication of preoperative platelet transfusion are not entirely clear. Methods: We designed a study to explore the prognostic impact of surgical methods, platelet count, and platelet transfusion in a large, single-institute, long-term cohort of ITP patients. Result: In 118 ITP patients, there was no difference between OS and LS in response and surgical complications. The overall response rate was 77% and the complete response (CR) rate was 70%. Patients with a CR had a trend towards a higher baseline platelet count. A stable platelet count 14-28 days after splenectomy was associated with a sustained long-term response. Patients requiring preoperative platelet transfusion had a lower preoperative platelet count and were more likely to need postoperative transfusion of red blood cells and platelets. They also had a lower postoperative platelet count than the nontransfusion group. Relapse-free survival did not differ. Conclusions: Baseline and postoperative platelet counts are apparently associated with the treatment response to splenectomy but the difference did not reach statistical significance. Preoperative platelet transfusion did not overcome the disadvantage of thrombocytopenia and was not recommended when other preparative measures are available.

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

et al. 2016

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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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Long-term Relapse-free Rurvival Rate and Predictive Factors of Idiopathic Thrombocytopenic Purpura in Adults Undergoing Splenectomy

Cited by 9 publications

References 30 publications

Clinical Outcome and Predictive Factors in the Response to Splenectomy in Elderly Patients with Primary Immune Thrombocytopenia: A Multicenter Retrospective Study

Clinical Outcome and Predictive Factors in the Response to Splenectomy in Elderly Patients with Primary Immune Thrombocytopenia: A Multicenter Retrospective Study

Impact of Platelet Counts, Surgical Methods, and Preoperative Platelet Transfusion on the Outcome of Splenectomy for Immune Thrombocytopenia

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

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