Response to splenectomy is durable after a certain point in time in adult patients with chronic immune thrombocytopenic purpura.
Splenectomy may lead to a good response in 60-80% of adult patients with corticosteroid refractory idiopathic thrombocytopenic purpura (ITP) but, the long-term response to splenectomy still remains less well defined. We assessed the long-term efficacy and safety of splenectomy in adult patients with chronic ITP. A cohort of 59 splenectomised ITP patients (M/F = 25/34; median age 39 yr; range 14-75) were followed up for a median of 18 yr (range 2-32). No life-threatening surgical complications were observed. The overall response rate was 78% with 59% complete remission (CR) and 19% partial remission (PR). CR and PR patients were younger than non-responding patients at time of diagnosis (median age: 36 yr vs 48 yr, P = 0.03) and at splenectomy (median age: 38 yr vs 51 yr, P = 0.02). Among the 46 responding patients, eventually 17 had relapse. No disease progression occurred after 12.1 and 7.3 yr for patients in CR or PR, respectively. One case of fatal septicaemia was recorded. We conclude that splenectomy is an effective and safe treatment in adult patients with chronic ITP failing to respond to corticosteroid treatment and importantly, our findings support the view that response to splenectomy is durable after a certain point in time.
Department of Medicine, Division of Hematology, Karolinska University Hospital and Institutet, Stockholm, Sweden. eva.mo.johansson@karolinska.se
Eva
E
Johansson
Per
P
Engervall
Ola
O
Landgren
Gunnar
G
Grimfors
Susanne
S
Widell
Shahideh
S
Rezai
Magnus
M
Björkholm
D000293:Adolescent; D000305:Adrenal Cortex Hormones / Q000627:therapeutic use; D000328:Adult; D000367:Age Factors; D000368:Aged; D002908:Chronic Disease; D018450:Disease Progression; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D016553:Purpura, Thrombocytopenic, Idiopathic / Q000601:surgery*; D012074:Remission Induction / Q000379:methods; D016879:Salvage Therapy / Q000379:methods; D013156:Splenectomy; D013997:Time Factors; D016896:Treatment Outcome
D000305:Adrenal Cortex Hormones