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

Jae Joon Han; Sun Kyung Baek; Jae Jin Lee; Si-Young Kim; Kyung Sam Cho; Hwi-Joong Yoon

doi:10.5045/kjh.2010.45.3.197

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Original Article

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Korean J Hematol 2010; 45(3):

Published online September 30, 2010

https://doi.org/10.5045/kjh.2010.45.3.197

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

Jae Joon Han, Sun Kyung Baek, Jae Jin Lee^*, Si-Young Kim, Kyung Sam Cho, and Hwi-Joong Yoon

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Department of Hematology-Oncology, School of Medicine, Kyung Hee University, Seoul, Korea.

Correspondence to : Correspondence to Jae Jin Lee, M.D. Department of Hematology & Medical Oncology, Gangdong Kyung Hee University Hospital, 149, Sangil-dong, Gangdong-gu, Seoul 134-890, Korea. Tel: +82-2-440-6123, Fax: +82-2-440-6295, lj2lj2@hanmail.net

Received: June 22, 2010; Revised: August 12, 2010; Accepted: September 2, 2010

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

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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.

Keywords Adult, Immune thrombocytopenic purpura, Long term, Splenectomy, Thrombocytopenia

Article

Original Article

Korean J Hematol 2010; 45(3): 197-204

Published online September 30, 2010 https://doi.org/10.5045/kjh.2010.45.3.197

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

Jae Joon Han, Sun Kyung Baek, Jae Jin Lee^*, Si-Young Kim, Kyung Sam Cho, and Hwi-Joong Yoon

Department of Hematology-Oncology, School of Medicine, Kyung Hee University, Seoul, Korea.

Correspondence to: Correspondence to Jae Jin Lee, M.D. Department of Hematology & Medical Oncology, Gangdong Kyung Hee University Hospital, 149, Sangil-dong, Gangdong-gu, Seoul 134-890, Korea. Tel: +82-2-440-6123, Fax: +82-2-440-6295, lj2lj2@hanmail.net

Received: June 22, 2010; Revised: August 12, 2010; Accepted: September 2, 2010

Abstract

Background

The long-term outcomes of adult patients with immune thrombocytopenic purpura (ITP) after splenectomy are not clear.

Methods

Results

Conclusion

Keywords: Adult, Immune thrombocytopenic purpura, Long term, Splenectomy, Thrombocytopenia

Abstract

Fig 1.

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Figure 1.

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

Blood Research 2010; 45: 197-204https://doi.org/10.5045/kjh.2010.45.3.197

Fig 2.

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Figure 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.

Blood Research 2010; 45: 197-204https://doi.org/10.5045/kjh.2010.45.3.197

Table 1 . Patient characteristics at diagnosis..

Thirty-one of the 44 patients who were available for follow-up for at least 1 year were analyzed. The median follow-up duration was 7 years (range: 1-25 years). No patients showed life threatening bleeding at diagnosis..

^a)Very severe: <10×10⁹/L; Severe: 10×10⁹/L-30×10⁹/L; Moderate: 30×10⁹/L-50×10⁹/L; Mild: >50×10⁹/L..

Abbreviations: PDL, prednisolone; IVIG, intravenous immunoglobulin..

Table 2 . Patient characteristics at splenectomy..

The median follow-up duration after splenectomy was 6 years (range, 1-21 years)..

^a)Active pulmonary tuberculosis, splenectomized during subtotal gastrectomy, splenectomy was done before pregnancy..

Table 3 . Response status during the follow-up period after splenectomy..

Overall response rate of splenectomy was 84% at 1 month and 55% at long-term follow-up..

^a)Two non-responders achieved complete response after 1 month of follow-up; ^b)Nine patients relapsed within 24 months after splenectomy, and 2 patients relapsed at 70 and 104 months, respectively..

Abbreviation: NA, not applicable..

Table 4 . Comparison between responsive group and non-responsive group after splenectomy..

Median (range)..

^a)Patients who achieved complete response and partial response at long-term follow-up after splenectomy were included..

Table 5 . Treatment after splenectomy of 14 patients that were non-responders or relapsed at the long-term follow-up..

^a)The cause of death was spontaneous bleeding associated with disseminated intravascular coagulopathy after surgery due to duodenal ulcer perforation..

Abbreviations: MPD, methylprenisolone; CR, complete response; PR, partial response; NR, no response; ITP, immune thrombocytopenic purpura; DIC, disseminated intravascular coagulopathy..