Splenectomy for adult chronic idiopathic thrombocytopenic purpura: experience from a single center in China

Wang, Tingting; Xu, Maoqiang; Ji, Linxiang; Han, Zhongchao; Yang, Renchi

doi:10.1111/j.1600-0609.2005.00517.x

Cited by 18 publications

(10 citation statements)

References 37 publications

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“…In this study, the response rate to splenectomy was 84% at 1 month after the splenectomy. The initial response rate of this study was similar to that of the prior reports [9, 11-18]. However, the response rate decreased to 77% at 6 months after the splenectomy and further decreased to 68% at 12 months and 55% at the last follow-up.…”

Section: Discussionsupporting

confidence: 89%

Long-term outcomes of a 5-year follow up of patients with immune thrombocytopenic purpura after splenectomy

et al. 2010

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BackgroundThe long-term outcomes of adult patients with immune thrombocytopenic purpura (ITP) after splenectomy are not clear.MethodsWe retrospectively analyzed 31 patients who underwent splenectomy after diagnosis of ITP at our institution between 1990 and 2009. Long-term follow-up was defined as a follow-up that lasted 1 year or more from splenectomy to the last follow-up.ResultsThe overall response rate to splenectomy was 84%. However, the response rate at 6 and 12 months decreased to 77% and 68%, respectively. During the 6 years of median follow-up after splenectomy, 11 patients (35%) relapsed. The long-term response rate was 55%. The long-term follow-up of 26 patients after responding to splenectomy showed that the median time from splenectomy to relapse was 19 months in the partial response (PR) group; however, there was no relapse after 9 months in the complete response (CR) group. Variables, including age, were not predictive of the long-term response after splenectomy. Additional treatment in patients who did not respond or relapsed after splenectomy was mostly effective. After a median follow-up of 7 years (range: 1-25 years) from the diagnosis, there were 2 deaths, including one due to spontaneous bleeding after repair of duodenal ulcer perforation.ConclusionAlthough splenectomy is safe and effective, the response rate after splenectomy continuously decreases over time. The duration of response is different between the patients that achieved CR and those that achieved PR. Factors, including age, were not predictors of a response to splenectomy.

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Section: Discussionsupporting

confidence: 89%

Long-term outcomes of a 5-year follow up of patients with immune thrombocytopenic purpura after splenectomy

et al. 2010

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“…In this study, only 16% of patients had undergone splenectomy because Chinese patients are reluctant to undergo this procedure (Wang et al, 2005). The Chinese Haematology Society's treatment guidelines (Thrombosis and Haemostasis Group, Haematology Society, Chinese Medical Association 2011) are generally aligned with those of the American Society of Hematology described in the introduction (Neunert et al, 2011), except that second-line treatment includes recombinant human thrombopoietin (Wang et al, 2012), which is approved in China.…”

Section: Discussionmentioning

confidence: 92%

Multicentre, randomised phaseIIIstudy of the efficacy and safety of eltrombopag in Chinese patients with chronic immune thrombocytopenia

Yang

Jin

et al. 2016

Br J Haematol

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SummaryEltrombopag, a thrombopoietin receptor agonist, raises platelet counts and reduces bleeding in patients with immune thrombocytopenia (ITP). In Chinese patients, eltrombopag was evaluated at an initial dose of 25 mg, vs. 50 mg for non-Asians, because the plasma exposure of eltrombopag is higher in East Asians. A multicentre, double-blind, randomised, placebocontrolled, 8-week, phase III study enrolled 155 patients with chronic, previously treated ITP. Dosage could be adjusted (25-75 mg/day) to maintain platelet counts 50-250 9 10 9 /l. The primary efficacy endpoint was the proportion of patients with a platelet count ≥50 9 10 9 /l after Day 42. Pharmacokinetics and pharmacodynamics of eltrombopag were analysed in an open-label extension. After Day 42, 57Á7% of eltrombopag-treated and 6Á0% of placebo-treated patients achieved platelet counts ≥50 9 10 9 /l.Odds of achieving a platelet count ≥50 9 10 9 /l were 26Á08 times greater with eltrombopag than placebo (P < 0Á001). Compared with placebo, time to response and duration of response were better with eltrombopag (P < 0Á001) and the odds of any bleeding were reduced by 72% (P = 0Á001). Tolerability, pharmacokinetics, and pharmacokinetics/pharmacodynamics were similar to previous findings in East Asian patients. In conclusion, in Chinese patients with chronic ITP, eltrombopag 25 mg once daily, elevated platelet counts to a safe range and reduced bleeding.

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“…) and the pooled ‘annualised’ cumulative incidence for TE was 1.29%/yr (Figure S2, Supporting information). Among studies which followed patients from their splenectomy procedures, the pooled ‘annualised’ cumulative risk for TE was 0.99%/yr (Fig. ).…”

Section: Resultsmentioning

confidence: 99%

Thromboembolism in adults with primary immune thrombocytopenia: a systematic literature review and meta‐analysis

Doobaree

Nandigam

Bennett

et al. 2016

European J of Haematology

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Adults with primary immune thrombocytopenia (ITP) may be susceptible to thromboembolism (TE). The objective of this systematic review was to evaluate studies that reported the prevalence and risk of developing TE in the ITP population from ITP diagnosis and splenectomy. We searched several bibliographic databases and included 29 studies. Using meta-analytical techniques, the pooled prevalence of TE before ITP diagnosis was 7.84% (arterial 6.25%; venous 1.95%). The pooled 'annualised' cumulative incidence (without prior TE) and cumulative risk (irrespective of prior TE) were 1.29%/yr and 3.00%/yr, respectively. Splenectomised patients had pooled cumulative risk of arterial TE (ATE) and venous TE (VTE) of 0.19%/yr and 1.10%/yr, respectively. In cohorts, regardless of a history of TE, the pooled relative risk (RR) of any TE was 1.60 (1.34, 1.86) for ITP vs. ITP-free individuals [arterial: 1.52 (1.25, 1.80); venous: 1.70 (0.96, 2.43)]. Splenectomised patients were at higher risk of venous events, pooled RR 2.39 (1.61, 3.17). To conclude, we found an increased risk of TE (mainly ATE) among ITP individuals and a higher risk of VTEs after splenectomy. How intrinsic (ITP pathophysiology, age, gender) and extrinsic factors (treatment) contribute to this risk could not be investigated here but is a task for future studies. Primary immune thrombocytopenia (ITP) in adults is a rare heterogeneous blood disorder which is characterised by a reduced peripheral blood platelet count below 100 9 10 9 /L (1). Its underlying mechanisms are increasingly explained within an 'autoimmune' paradigm in which platelets are destroyed through antibody-mediated destruction and thrombocytopoiesis is reduced through immune-mediated megakaryocytic downregulation (2).Although bleeding is a prominent feature of the disease, patients often present with other comorbid conditions at ITP diagnosis or throughout the course of the disease (3, 4). Notably, there are studies that showed that the risk of thromboembolic events (TE) could be elevated among patients with ITP (4, 5) and also among patients who had ITP-related splenectomies (6). How such a paradoxical 'prothrombotic and thrombocytopenic' state coexists is not completely understood. One likely explanation for this heightened risk for TE is that the ITP pathophysiology promotes a prothrombotic state but the evidence is unclear and weak (7-9). On the other hand, the distribution and influence of typical prothrombotic risk factors, including obesity, smoking, family history of TE, and the impact of ITP-related treatments, such as long-term corticosteroid use or splenectomy, on the risk of TE in ITP have been not completely described and explained. Before engaging into investigative studies on the contributory factors of TE in ITP, it is important to review the published evidence to date to establish whether there is a heightened risk of TE in the ITP population.

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Splenectomy for adult chronic idiopathic thrombocytopenic purpura: experience from a single center in China

Cited by 18 publications

References 37 publications

Long-term outcomes of a 5-year follow up of patients with immune thrombocytopenic purpura after splenectomy

Long-term outcomes of a 5-year follow up of patients with immune thrombocytopenic purpura after splenectomy

Multicentre, randomised phaseIIIstudy of the efficacy and safety of eltrombopag in Chinese patients with chronic immune thrombocytopenia

Thromboembolism in adults with primary immune thrombocytopenia: a systematic literature review and meta‐analysis

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