Splenectomy for primary immune thrombocytopenia revisited in the era of thrombopoietin receptor agonists: New insights for an old treatment

Mageau, Arthur; Terriou, Louis; Ebbo, Mikaël; Souchaud-Debouverie, O.; Orvain, Corentin; Graveleau, J.; Lega, Jean‐Christophe; Ruivard, M.; Viallard, Jean‐François; Chèze, Stéphane; Dossier, Antoine; Bonnotte, Bernard; Perlat, Antoinette; Gobert, Delphine; Costédoat-Chalumeau, Nathalie; Jeandel, Pierre-Yves; Dernoncourt, A.; Michel, Marc; Godeau, Bertrand; Comont, T.

doi:10.1002/ajh.26378

Cited by 26 publications

(50 citation statements)

References 24 publications

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“…Some treatment options for ITP are costly and require long-term treatment, others are less expensive but have significant side effects. Splenectomy is considered to be the effective treatment for ITP, however prospective studies 5 have shown that with the advent of newer second-line therapy drugs such as thrombopoietin receptor agonist (TPO-RA), the clinical use rate of splenectomy for ITP is gradually decreased. 6 Nazy et al 7 have found that TPO and TPO receptor (C-MPL) autoantibodies were detectable in 44% of patients with ITP and other thrombocytopenic diseases.…”

Section: Discussionmentioning

confidence: 99%

The Value of Combined Detection of Megakaryocyte and Platelet Parameters for the Diagnosis of Primary Immune Thrombocytopenia

Wang

Tao

Zhang

et al. 2022

Clin Appl Thromb Hemost

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Objective:To investigate the application value of bone marrow megakaryocyte count, the proportion of megakaryocytes at each stage, and the platelet parameter in the clinical diagnosis of primary immune thrombocytopenia (ITP). Methods: The megakaryocyte and platelet parameter level in 62 ITP and 40 control group patients were compared and analyzed. Linear correlation analysis, Pearson correlation analysis, and ROC curves were performed for the correlation between megakaryocytes and platelet parameters. Results: Compared to the control group, the total number of megakaryocytes, the promegakaryocytes the granular megakaryocytes (GMeg), and naked megakaryocytes (NMeg), MPV, and P-LCR% in the ITP group increased. All differences were statistically significant ( P<0.05). While the proportion of platelet-producing megakaryocytes (PMeg), PLT, and PCT decreased in the ITP group. These differences were statistically significant ( P < 0.05). PLT was strongly positively correlated with PCT (r = 0.921, p<0.01). PCT was weakly positively with MPV (r = 0.309, p<0.05). MPV was positively correlated with P-LCR (r = 0.856, p<0.01). PDW was weakly positively correlated with P-LCR (r = 0.296, p<0.05) and Meg (r = 0.301, p<0.05), and negatively correlated with PMeg (r = -0.336, p<0.05). ROC curve analysis showed that PLT, PCT MPV and P-LCR% gave a high sensitivity（100.0%，81.0%，74.6%，90.5%，respectively.) and specificity (100.0%, 92.5%, 80.0%, 77.5%, respectively.) in diagnosis of ITP. Conclusion: The combined analysis of bone marrow megakaryocyte count, the proportion of megakaryocyte classification at each stage, and platelet parameters have an important reference value for auxiliary diagnosis of ITP.

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Section: Discussionmentioning

confidence: 99%

The Value of Combined Detection of Megakaryocyte and Platelet Parameters for the Diagnosis of Primary Immune Thrombocytopenia

Wang

Tao

Zhang

et al. 2022

Clin Appl Thromb Hemost

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“…This leaves splenectomy which is remarkably effective; recent work suggests that it remains effective even in patients who have been treated with thrombopoietin agents. 48 Why are patients so unwilling to undergo splenectomy? Perhaps the primary reasons are the inability to know whether a patient will get better on their own, whether the splenectomy will be successful, and the irreversibility of it.…”

Section: Discussionmentioning

confidence: 99%

“…Late relapse beyond 2 years after splenectomy is very uncommon. Whether delaying splenectomy reduces its efficacy is a concern; a recent study from France 48 suggests that efficacy is maintained, and some patients responded better to TPO-RA after splenectomy.…”

Section: Section I a Young Female Patient With Immune Thrombocytopeni...mentioning

confidence: 99%

Diagnosis of immune thrombocytopenia, including secondary forms, and selection of second-line treatment

Bussel

Garcia

2022

haematol

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This article summarizes our approach to the diagnosis, secondary ITP, and choice of second line options in patients with immune thrombocytopenic (ITP). We very briefly summarize first-line treatment and then utilize a case-based approach. We will first explore persistent-chronic ITP in a younger female. We consider many possibilities beyond primary ITP e.g., hypogammaglobulinemia, chronic infection, and anemia, and how to approach their diagnosis and management. The journey continues throughout pregnancy and post-partum and eventually includes fourth-line treatment after a late relapse. We then consider an older male, emphasizing differences in diagnostic considerations and management. The focus is on initiation and continuation of second line treatment, pros and cons of each option, and briefly the impact of treatment choices related to endemic presence of SARS-CoV-2. During review of potential second-line treatment options, we also briefly touch upon novel treatments. Finally, there is a short section on refractory disease drawn from our extensive review in Blood in February 2020(1). The clinical nature of the discussions replete with figures and tables and with interspersion of pearls regarding efficacy and toxicity at different ages and genders, will serve the reader in management of “typical” adult patients who develop persistent and chronic ITP.

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“…Splenectomy remains the most effective therapy for corticosteroid-resistant or relapsed ITP patients by removing the major site of platelet phagocytosis and autoantibody production. Although splenectomy is becoming less preferred nowadays due to the availability of emerging non-surgical medications, it still offers the best chance for long-lasting remission, with an estimated durable response rate of 60–70% [ 148 ], even in TPO-RA and/or rituximab-resistant or relapsed patients [ 149 ]. There is also evidence that even though CR was not achieved after splenectomy, most patients displayed a milder course of the disease and responded better to medical treatment [ 149 , 150 ].…”

Section: Subsequent Treatmentmentioning

confidence: 99%

“…Although splenectomy is becoming less preferred nowadays due to the availability of emerging non-surgical medications, it still offers the best chance for long-lasting remission, with an estimated durable response rate of 60–70% [ 148 ], even in TPO-RA and/or rituximab-resistant or relapsed patients [ 149 ]. There is also evidence that even though CR was not achieved after splenectomy, most patients displayed a milder course of the disease and responded better to medical treatment [ 149 , 150 ]. Most guidelines recommend deferring splenectomy for 12–24 months after diagnosis as some patients have a chance of spontaneous remission or stabilization of platelet count at a hemostatic level [ 11 , 12 ].…”

Section: Subsequent Treatmentmentioning

confidence: 99%

How we treat primary immune thrombocytopenia in adults

Liu

Hou

2023

J Hematol Oncol

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Primary immune thrombocytopenia (ITP) is an immune-mediated bleeding disorder characterized by decreased platelet counts and an increased risk of bleeding. Multiple humoral and cellular immune abnormalities result in accelerated platelet destruction and suppressed platelet production in ITP. The diagnosis remains a clinical exclusion of other causes of thrombocytopenia. Treatment is not required except for patients with active bleeding, severe thrombocytopenia, or cases in need of invasive procedures. Corticosteroids, intravenous immunoglobulin, and anti-RhD immunoglobulin are the classical initial treatments for newly diagnosed ITP in adults, but these agents generally cannot induce a long-term response in most patients. Subsequent treatments for patients who fail the initial therapy include thrombopoietic agents, rituximab, fostamatinib, splenectomy, and several older immunosuppressive agents. Other potential therapeutic agents, such as inhibitors of Bruton’s tyrosine kinase and neonatal Fc receptor, are currently under clinical evaluation. An optimized treatment strategy should aim at elevating the platelet counts to a safety level with minimal toxicity and improving patient health-related quality of life, and always needs to be tailored to the patients and disease phases. In this review, we address the concepts of adult ITP diagnosis and management and provide a comprehensive overview of current therapeutic strategies under general and specific situations.

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Splenectomy for primary immune thrombocytopenia revisited in the era of thrombopoietin receptor agonists: New insights for an old treatment

Cited by 26 publications

References 24 publications

The Value of Combined Detection of Megakaryocyte and Platelet Parameters for the Diagnosis of Primary Immune Thrombocytopenia

The Value of Combined Detection of Megakaryocyte and Platelet Parameters for the Diagnosis of Primary Immune Thrombocytopenia

Diagnosis of immune thrombocytopenia, including secondary forms, and selection of second-line treatment

How we treat primary immune thrombocytopenia in adults

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