title: Does the site of platelet sequestration predict the response to splenectomy in adult patients with immune thrombocytopenic purpura?
abstract: Splenectomy is the only potentially curative treatment for chronic immune thrombocytopenic purpura (ITP) in adults. However, one-third of the patients relapse without predictive factors identified. We evaluate the predictive value of the site of platelet sequestration on the response to splenectomy in patients with ITP. Eighty-two consecutive patients with ITP treated by splenectomy between 1992 and 2013 were retrospectively reviewed. Platelet sequestration site was studied by (111)Indium-oxinate-labeled platelets in 93% of patients. Response to splenectomy was defined at last follow-up as: complete response (CR) for platelet count (PC) ≥100 × 10(9)/L, response (R) for PC≥30 × 10(9)/L and <100 × 10(9)/L with absence of bleeding, no response (NR) for PC<30 × 10(3)/L or significant bleeding. Laparoscopic splenectomy was performed in 81 patients (conversion rate of 16%), and open approach in one patient. Median follow-up was 57 months (range, 1-235). Platelet sequestration study was performed in 93% of patients: 50 patients (61%) exhibited splenic sequestration, 9 (11%) hepatic sequestration and 14 patients (17%) mixed sequestration. CR was obtained in 72% of patients, R in 25% and NR in 4% (two with splenic sequestration, one with hepatic sequestration). Preoperative PC, age at diagnosis, hepatic sequestration and male gender were significant for predicting CR in univariate analysis, but only age (HR = 1.025 by one-year increase, 95% CI [1.004-1.047], p = 0.020) and pre-operative PC (HR = 0.112 for > 100 versus <=100, 95% CI [0.025-0.493], p = 0.004) were significant predictors of recurrence-free survival in multivariate analysis. Response to splenectomy was independent of the site of platelet sequestration in patients with ITP. Pre-operative platelet sequestration study in these patients cannot be recommended.
authors.affiliation: Department of Abdominal Surgery and Transplantation, Cliniques Universitaires Saint-Luc (Université Catholique de Louvain) , Brussels , Belgium.
authors.forename: Julie
authors.initials: J
authors.lastname: Navez
authors.forename: Catherine
authors.initials: C
authors.lastname: Hubert
authors.forename: Jean-François
authors.initials: JF
authors.lastname: Gigot
authors.forename: Benoit
authors.initials: B
authors.lastname: Navez
authors.forename: Catherine
authors.initials: C
authors.lastname: Lambert
authors.forename: François
authors.initials: F
authors.lastname: Jamar
authors.forename: Etienne
authors.initials: E
authors.lastname: Danse
authors.forename: Valérie
authors.initials: V
authors.lastname: Lannoy
authors.forename: Nicolas
authors.initials: N
authors.lastname: Jabbour
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001792:Blood Platelets / Q000276:immunology*; D001853:Bone Marrow / Q000473:pathology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010976:Platelet Count; D016553:Purpura, Thrombocytopenic, Idiopathic / Q000097:blood / Q000175:diagnosis / Q000276:immunology* / Q000601:surgery*; D012189:Retrospective Studies; D012307:Risk Factors; D013156:Splenectomy / Q000379:methods; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D055815:Young Adult
keywords: Immune thrombocytopenic purpura; platelet sequestration study; predictive factors; splenectomy