Splenectomy for immune thrombocytopenic purpura: long-term results and treatment of postsplenectomy relapses

Shaji Kumar, S. Kumar, F. Diehn, Felix E. Diehn, MA Gertz, M. Gertz, A. Tefferi, Ayalew Tefferi
Annals of Hematology · 2002 · vol. 81(6) , pp. 312–319 · doi:10.1007/s00277-002-0461-8 · PMID:12107560 · W2054111587
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Splenectomy in 140 adult ITP patients resulted in an 88% initial response, with younger age and higher peak platelet counts predicting a favorable outcome, and various medications proving effective for relapses.

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This retrospective study evaluated long-term outcomes after therapeutic splenectomy in 140 adult patients with immune thrombocytopenic purpura (ITP), reporting sustained platelet responses and factors associated with prognosis. Eighty-eight percent achieved either complete or partial responses sustained for at least 1 month, with time-adjusted complete response rates of 77% at 3 months, 71% at 6 months, and 74% at 12 months, and a 5-year relapse-free survival of 75% with most relapses occurring within 2 years. In multivariate analysis, younger age and higher peak postsplenectomy platelet counts were associated with a favorable response, while no preoperative or perioperative variables predicted relapse after initial response; the paper also notes a limitation of limited available prognostic data and focuses on single-institution experience. Treatments for post-splenectomy relapse included corticosteroids, danazol, vincristine, and cyclophosphamide, with one rituximab response after failure of several other agents, and there were 25 deaths including some related to thrombocytopenia or sepsis. The paper does not explicitly discuss endometriosis or adenomyosis; it was included in the corpus via a keyword match in the upstream search index.

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Abstract. Information regarding prognostic determinants of outcome after splenectomy for adult immune thrombocytopenic purpura (ITP) and the management of postsplenectomy relapse is limited. Among 140 adult patients with ITP who had therapeutic splenectomy at our institution, 88% achieved either a complete (platelets >150×109/l) or a partial (platelets ≥50×109/l) response that was sustained for at least 1 month. At 3, 6, and 12 months after splenectomy, time-adjusted complete response rates were 77%, 71%, and 74%, respectively. The 5-year relapse-free survival was 75%; all but three relapses occurred within 2 years of splenectomy. In multivariate analysis, younger age and higher peak postsplenectomy platelet counts were significantly associated with a favorable response to splenectomy. None of several preoperative or perioperative variables was predictive of a relapse after an initial response to splenectomy. Corticosteroids, danazol, vincristine, and cyclophosphamide were often effective in the treatment of patients who were either refractory to or had a relapse after splenectomy. One patient responded to rituximab after not responding to corticosteroids, azathioprine, and vincristine. After a median follow-up of 37.5 months (range: 0–183) from splenectomy, there were 25 deaths, including 2 from postoperative complications, 1 from gastrointestinal bleeding related to thrombocytopenia, and 1 from overwhelming sepsis related to the splenectomized state. The current study provides additional data on both the long-term outcome of splenectomy in adults with ITP and the management of postsplenectomy relapse. Similar content being viewed by others Author information Authors and Affiliations Additional information Electronic Publication Rights and permissions About this article Cite this article Kumar, S., Diehn, F., Gertz, M. et al. Splenectomy for immune thrombocytopenic purpura: long-term results and treatment of postsplenectomy relapses. Ann Hematol 81, 312–319 (2002). https://doi.org/10.1007/s00277-002-0461-8 Received: Accepted: Published: Issue date: DOI: https://doi.org/10.1007/s00277-002-0461-8

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