title: Reemergence of Splenectomy for ITP Second-line Treatment?
abstract: BACKGROUND
  Corticosteroids are still the standard first-line treatment for immune thrombocytopenic purpura (ITP). As second-line therapy, splenectomy and Rituximab are both recommended. The aim of our study was to compare the efficacy of Rituximab to splenectomy in persistent or chronic ITP patients.
  
  
  METHODS
  Between January 1999 and March 2015, we retrospectively selected all consecutive patients who underwent an ITP second-line treatment: Rituximab or splenectomy. The distinction between open (OS) and laparoscopic splenectomy (LS) was analyzed. Primary outcome was composite: hospitalization for bleeding and/or thrombocytopenia and death from hemorrhage or infection. Secondary outcomes were based on response (R) and complete response (CR) rates as defined by the American Society of Hematology.
  
  
  RESULTS
  Ninety-six patients were included: 30 patients received Rituximab, 37 underwent OS, and 29 underwent LS. The follow-up was 30, 60, and 120 months in Rituximab, LS, and OS groups, respectively. At 30 month, the primary outcome-free survival rate was higher in splenectomy groups (84% for OS, 86% for LS) than Rituximab group (47%) (P = 0.0002). Similarly, at 30 month, R and CR rates were higher for OS (86.5% and 75.7%, respectively) and LS groups (93.1% and 89.7%) than Rituximab (46.7% and 30%) (P = 0.0001). Moreover, R rates remained elevated at 60 month for OS and LS groups (83.7% and 89.6% respectively) and 78.4% at 120 month for OS group.
  
  
  CONCLUSIONS
  We observed that splenectomy for ITP second-line treatment was more effective than Rituximab regarding maintenance of R, CR, and overall response rates. OS and LS had similar efficacy.
authors.affiliation: *Department of General Surgery and Transplantation, Université Nord de France, Lille, France †Internal Medecine Unit, Université Nord de France, Lille, France ‡Biostatistic Unit, Université Nord de France, Lille, France.
authors.forename: Charbel
authors.initials: C
authors.lastname: Chater
authors.forename: Louis
authors.initials: L
authors.lastname: Terriou
authors.forename: Alain
authors.initials: A
authors.lastname: Duhamel
authors.forename: David
authors.initials: D
authors.lastname: Launay
authors.forename: Jean P
authors.initials: JP
authors.lastname: Chambon
authors.forename: François R
authors.initials: FR
authors.lastname: Pruvot
authors.forename: Moshe
authors.initials: M
authors.lastname: Rogosnitzky
authors.forename: Philippe
authors.initials: P
authors.lastname: Zerbib
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D007155:Immunologic Factors / Q000627:therapeutic use; D010535:Laparoscopy; D008297:Male; D008875:Middle Aged; D016553:Purpura, Thrombocytopenic, Idiopathic / Q000188:drug therapy / Q000601:surgery*; D012008:Recurrence; D019233:Retreatment; D012189:Retrospective Studies; D000069283:Rituximab / Q000627:therapeutic use; D013156:Splenectomy; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D007155:Immunologic Factors; D000069283:Rituximab