Korean J Hematol.  2010 Sep;45(3):197-204. 10.5045/kjh.2010.45.3.197.

Long-term outcomes of a 5-year follow up of patients with immune thrombocytopenic purpura after splenectomy

• Han JJ
• Baek SK
• Lee JJ
• Kim SY
• Cho KS
• Yoon HJ

• KMID: 2252064
• DOI: http://doi.org/10.5045/kjh.2010.45.3.197

Abstract

BACKGROUND
The long-term outcomes of adult patients with immune thrombocytopenic purpura (ITP) after splenectomy are not clear.
METHODS
We retrospectively analyzed 31 patients who underwent splenectomy after diagnosis of ITP at our institution between 1990 and 2009. Long-term follow-up was defined as a follow-up that lasted 1 year or more from splenectomy to the last follow-up.
RESULTS
The overall response rate to splenectomy was 84%. However, the response rate at 6 and 12 months decreased to 77% and 68%, respectively. During the 6 years of median follow-up after splenectomy, 11 patients (35%) relapsed. The long-term response rate was 55%. The long-term follow-up of 26 patients after responding to splenectomy showed that the median time from splenectomy to relapse was 19 months in the partial response (PR) group; however, there was no relapse after 9 months in the complete response (CR) group. Variables, including age, were not predictive of the long-term response after splenectomy. Additional treatment in patients who did not respond or relapsed after splenectomy was mostly effective. After a median follow-up of 7 years (range: 1-25 years) from the diagnosis, there were 2 deaths, including one due to spontaneous bleeding after repair of duodenal ulcer perforation.
CONCLUSION
Although splenectomy is safe and effective, the response rate after splenectomy continuously decreases over time. The duration of response is different between the patients that achieved CR and those that achieved PR. Factors, including age, were not predictors of a response to splenectomy.

Keyword

Adult; Immune thrombocytopenic purpura; Long term; Splenectomy; Thrombocytopenia

MeSH Terms

Adult
Duodenal Ulcer
Follow-Up Studies
Hemorrhage
Humans
Purpura, Thrombocytopenic, Idiopathic
Recurrence
Retrospective Studies
Splenectomy
Thrombocytopenia

Figure

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  Fig. 1 Progression-free survival of all 31 patients after splenectomy. Median time of progression-free survival was 70 months.

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  Fig. 2 Kaplan-Meier curve of remission (CR+PR) duration in 26 patients after responding to splenectomy. Median time from splenectomy to relapse was 19 months in PR patients. However, no relapse occurred after 9 months in CR patients. CR, complete response; PR, partial response.

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