Clinical Outcome and Predictive Factors in the Response to Splenectomy in Elderly Patients with Primary Immune Thrombocytopenia: A Multicenter Retrospective Study

Acta Haematologica
Young Hoon ParkGyeonggi/Incheon Branch, The Korean Society of Hematology

Abstract

Because many physicians seem reluctant to recommend splenectomy for elderly patients with immune thrombocytopenia (ITP), we investigated the safety and efficacy of splenectomy and the predictive factors for response in these patients. 184 patients with primary ITP were retrospectively analyzed based on age at splenectomy: an elderly group (≥60 years, n = 52) and a younger group (<60 years, n = 132). There was no difference in the response rate of elderly versus younger patients (80.7 vs. 80.3%, p = 0.466). Relapse (45.2 vs. 22.6%, p = 0.006), complications, and median postoperative stay (9.5 vs. 7 days, p = 0.019) were significantly higher in the elderly group. The 5-year relapse-free survival of responders was 51.8% in the elderly group and 76.3% in the younger group (p = 0.002). Response to any treatment before splenectomy (HR 2.9, 95% CI: 1.24-6.80, p = 0.014) and platelet count on postoperative day 14 ≥200 × 109/l (HR 31.43, 95% CI: 4.15-238.28, p = 0.001) were independent factors for a favorable response. Age ≥60 years did not influence the response to splenectomy but was associated with increased relapse and postoperative complications. Splenectomy could provide a durable long-term response for elderly ITP patients.

Citations

Jan 4, 2018·Blood·Shruti ChaturvediKeith R McCrae
Feb 27, 2018·British Journal of Haematology·Francesco Rodeghiero
Dec 7, 2018·Hematology·Cindy E Neunert, Nichola Cooper
Sep 5, 2019·The New England Journal of Medicine·Nichola Cooper, Waleed Ghanima
Dec 17, 2019·European Journal of Haematology·Tomás José González-LópezLuis Javier García-Frade
Oct 19, 2016·European Journal of Haematology·Yue GuanRenchi Yang
Jul 6, 2016·Current Opinion in Hematology·Adam CukerCindy E Neunert
Dec 4, 2019·Blood Advances·Cindy NeunertSara K Vesely
Mar 7, 2021·Journal of Clinical Medicine·Anurag SinghTamam Bakchoul
Mar 17, 2021·Expert Review of Clinical Pharmacology·Rajeev SandalAhmad Daniyal Siddiqui

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