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. 2010 Sep;45(3):197-204.
doi: 10.5045/kjh.2010.45.3.197. Epub 2010 Sep 30.

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

Jae Joon Han  1 , Sun Kyung Baek, Jae Jin Lee, Si-Young Kim, Kyung Sam Cho, Hwi-Joong Yoon
Affiliations

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

Jae Joon Han et al. Korean J Hematol. 2010 Sep.

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.

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Figures

Fig. 1
Fig. 1
Progression-free survival of all 31 patients after splenectomy. Median time of progression-free survival was 70 months.
Fig. 2
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.
See this image and copyright information in PMC

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