title: Splenectomy as a curative treatment for immune thrombocytopenia: a retrospective analysis of 233 patients with a minimum follow up of 10 years.
abstract: The treatment of choice in steroid-resistant immune thrombocytopenia is still controversial due to the recent advent of new drugs (anti-CD20 antibodies and thrombopoietin mimetics) that have encouraged a generalized tendency to delay splenectomy. Consequently, it is extremely importance to define the efficacy and safety of splenectomy in the long term. We retrospectively analyzed the data of 233 patients affected by immune thrombocytopenia who underwent splenectomy between 1959 and 2001 in 6 European hematologic institutions and who have now a minimum follow up of ten years from surgery. Of the 233 patients, 180 (77%) achieved a complete response and 26 (11%) a response. Sixty-eight of 206 (33%) responsive patients relapsed, mostly (75%) within four years from first response. In 92 patients (39.5%), further treatment was required after splenectomy that was effective in 76 cases (83%). In 138 patients (59%), response was maintained free of any treatment at last contact. No significant association between baseline characteristics and likelihood of stable response was found. Overall, 73 (31%) and 58 (25%) patients experienced at least one infectious or hemorrhagic complication, which was fatal in 2 and 3 patients, respectively. A stable response to splenectomy was associated with a lower rate of infections (P=0.004) and hemorrhages (P<0.0001). Thrombosis developed in 18 patients (8%) and was fatal in 4. Splenectomy achieved a long-term stable response in approximately 60% of cases. Complications mainly affected non-responding patients and were fatal in a minority.
authors.affiliation: Department of Hematology and Clinical Oncology L. and A. Seràgnoli, University of Bologna, S. Orsola-Malpighi Hospital, Italy. nicola.vianelli@unibo.it
authors.forename: Nicola
authors.initials: N
authors.lastname: Vianelli
authors.forename: Francesca
authors.initials: F
authors.lastname: Palandri
authors.forename: Nicola
authors.initials: N
authors.lastname: Polverelli
authors.forename: Roberto
authors.initials: R
authors.lastname: Stasi
authors.forename: Joel
authors.initials: J
authors.lastname: Joelsson
authors.forename: Eva
authors.initials: E
authors.lastname: Johansson
authors.forename: Marco
authors.initials: M
authors.lastname: Ruggeri
authors.forename: Francesco
authors.initials: F
authors.lastname: Zaja
authors.forename: Silvia
authors.initials: S
authors.lastname: Cantoni
authors.forename: Angelo Emanuele
authors.initials: AE
authors.lastname: Catucci
authors.forename: Anna
authors.initials: A
authors.lastname: Candoni
authors.forename: Enrica
authors.initials: E
authors.lastname: Morra
authors.forename: Magnus
authors.initials: M
authors.lastname: Björkholm
authors.forename: Michele
authors.initials: M
authors.lastname: Baccarani
authors.forename: Francesco
authors.initials: F
authors.lastname: Rodeghiero
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002648:Child; D002675:Child, Preschool; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D007223:Infant; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology; D011379:Prognosis; D016553:Purpura, Thrombocytopenic, Idiopathic / Q000188:drug therapy / Q000401:mortality / Q000601:surgery*; D012189:Retrospective Studies; D013156:Splenectomy; D016896:Treatment Outcome; D055815:Young Adult