Korean J Hematol 1999; 34(4):
Published online December 31, 1999
© The Korean Society of Hematology
최철원, 윤소영, 백창원, 최인근, 서재홍, 김병수, 신상원, 김열홍, 김준석
고려대학교 의과대학 내과학교실
BACKGROUND: In the treatment of adult patients with idiopathic thrombocytopenic purpura(ITP), prednisone is the initial therapy. Splenectomy is the treatment of choice in patient who are refractory to prednisone therapy and reported overall response rate to splenectomy is about 50 to 80%. We reviewed the long-term response to splenectomy and attempted to find any factors predicting which patient would have a good response.
METHODS: We studied retrospectively 39 patients with chronic ITP who had first been treated with prednisone alone or with prednisone and immune globulin and then undergone splenectomy. The response to the treatment was classified on the basis of the platelet count as no response (<50,000/micro L), incomplete response
(50,000~150,000/micro L), or complete response (>150,000/micro L). The response was evaluated within 2 weeks after splenectomy (immediate response) and during follow-up period (follow-up response).
RESULTS: The median age of patients was 30 (range: 18~72) and the ratio of male to female was 13:26. Immediately after splenectomy, complete response was obtained by 30 patients while 6 had incomplete response and in 3 patients splenectomy failed. Among 39 patients, follow-up evaluation was obtained in 32 patients. During the follow-up period (mean duration of follow-up was 23 months), 9 patients relapsed after splenectomy and the sustained response (continued complete or incomplete response for more than 3 months without any treatment) was observed in 62.5% of the patients. Postsplenectomy thrombocytosis was an early feature of durable response. Among 39 patients, intravenous immune globulin was administered in 28 patients before splenectomy, and response to immune globulin was also a favorable factor to sustain the response.
CONCLUSION: Patients who do not have responses to intravenous immune globulin may still respond to splenectomy initially, but are unlikely to sustain response for a long time.
Keywords ITP, Splenectomy, Immune Globulin, Response, Prognostic Factor
Korean J Hematol 1999; 34(4): 513-520
Published online December 31, 1999
Copyright © The Korean Society of Hematology.
최철원, 윤소영, 백창원, 최인근, 서재홍, 김병수, 신상원, 김열홍, 김준석
고려대학교 의과대학 내과학교실
Chul Won Choi, So Young Yoon, Chang Won Paek, In Keun Choi, Jae Hong Seo, Byung Soo Kim, Sang Won Shin, Yeul Hong Kim, Jun Suk Kim
Department of Internal Medicine, College of Medicine, Korea University, Seoul, Korea
BACKGROUND: In the treatment of adult patients with idiopathic thrombocytopenic purpura(ITP), prednisone is the initial therapy. Splenectomy is the treatment of choice in patient who are refractory to prednisone therapy and reported overall response rate to splenectomy is about 50 to 80%. We reviewed the long-term response to splenectomy and attempted to find any factors predicting which patient would have a good response.
METHODS: We studied retrospectively 39 patients with chronic ITP who had first been treated with prednisone alone or with prednisone and immune globulin and then undergone splenectomy. The response to the treatment was classified on the basis of the platelet count as no response (<50,000/micro L), incomplete response
(50,000~150,000/micro L), or complete response (>150,000/micro L). The response was evaluated within 2 weeks after splenectomy (immediate response) and during follow-up period (follow-up response).
RESULTS: The median age of patients was 30 (range: 18~72) and the ratio of male to female was 13:26. Immediately after splenectomy, complete response was obtained by 30 patients while 6 had incomplete response and in 3 patients splenectomy failed. Among 39 patients, follow-up evaluation was obtained in 32 patients. During the follow-up period (mean duration of follow-up was 23 months), 9 patients relapsed after splenectomy and the sustained response (continued complete or incomplete response for more than 3 months without any treatment) was observed in 62.5% of the patients. Postsplenectomy thrombocytosis was an early feature of durable response. Among 39 patients, intravenous immune globulin was administered in 28 patients before splenectomy, and response to immune globulin was also a favorable factor to sustain the response.
CONCLUSION: Patients who do not have responses to intravenous immune globulin may still respond to splenectomy initially, but are unlikely to sustain response for a long time.
Keywords: ITP, Splenectomy, Immune Globulin, Response, Prognostic Factor
Doaa Mohamed El Demerdash, Maha Mohamed Saber, Alia Ayad, Kareeman Gomaa and Mohamed Abdelkader Morad
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