THE OUTCOME of SPLENECTOMY in REFRACTORY ITP is POOR: AN ANALYSIS of REAL WORLD UKITP REGISTRY DATA.
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All Authors
Chen, F.
Todd, S.
Miah, H.
Allsup, D.
Cooper, N.
Bagot, C.
Biss, T.
Scully, M.
Almusawy, M.
Czuprynska, J.
LTHT Author
Hill, Quentin
LTHT Department
Oncology
Haematology
Haematology
Non Medic
Publication Date
2024
Item Type
Conference Abstract
Language
Subject
ADULT , AGED , COHORT STUDIES , DRUG THERAPY , WOMEN , FOLLOW-UP-STUDIES , MEN , OBSERVATIONAL STUDIES AS TOPIC , REMISSION INDUCTION , RETROSPECTIVE STUDIES , GENERAL SURGERY , TREATMENT OUTCOME , IMMUNOSUPPRESSIVE AGENTS , ADRENAL CORTEX HORMONES , STEROIDS , ANTIBODIES, MONOCLONAL
Subject Headings
Abstract
Background: The use of splenectomy for ITP has declined significantly since the use of rituximab and thrombopoietin receptor agonists (TPO-RA), and has been relegated from second line therapy to treatment of last resort. Recent studies suggest that splenectomy confers long-term remission both early and late in the therapeutic pathway, but is underutilised. To reassess the role and efficacy of splenectomy in contemporary practice, we assessed its efficacy in refractory patients who have had more than three lines of ITP therapy. Aim(s): To reassess the role and efficacy of splenectomy in refractory patients who have had more than 3 lines of ITP therapy. Method(s): We reviewed real-world data of the UK-ITP registry. Of 5322 enrolled patients, 410 patients who received splenectomy were identified. Two hundred fifty-one patients underwent a splenectomy after year 2000, when the procedure was increasingly used for refractory patients. We stratified the patients into two cohorts consisting of 1) patients who had <= 2 lines of therapy prior to splenectomy (n=102), and 2) patients who had >=3 lines of therapy (n=149). The latter cohort is generally defined as refractory ITP. Result(s): One hundred-thirteen (45%) patients were male and 138 (55%) female. The median age at splenectomy was 38.7 years. We stratified the patients into two cohorts consisting of 1) patients who had <= 2 lines of therapy prior to splenectomy (n=102), and 2) patients who had >=3 lines of therapy (n=149). The latter cohort is generally defined as refractory ITP. As a surrogate measure of splenectomy failure, the median time-to-first treatment after splenectomy in cohort 1 was calculated as 20.83 (R:6.97-84) months. The time-to-first treatment post-splenectomy in cohort 2 was 3.02 (R:0.69-12.99) months. By using time-to-first treatment post-splenectomy, patients who had rescue or concomitant treatments during post-splenectomy follow-up were excluded. In the first cohort, treatment received before splenectomy consisted of corticosteroids and/or ivIg in n=47(46.1%); no treatment, n= 48(47%); rituximab, n= 2(2%) and mycophenolate mofetil (MMF), n=2 (2%). In the refractory group, the last treatment received before splenectomy were corticosteroids and/or ivIg, n=104(70%); n=13(8.7%) TPO-RA, rituximab, n=9(6%): MMF, n=6(4%); danazol, n=4(2.7%); azathioprine, n= 7(4.7%); ciclosporin, n=2(1.3%). Summary/Conclusion: Splenectomy achieved good responses if positioned early in the therapeutic pathway, mostly as second line therapy. When used in refractory cases, defined as having had 3 or more lines of therapy, the response rate is poor. Although current practice considers splenectomy as last resort treatment, the probability of sustainable remission in the latter setting is extremely low. Although this does not exclude the use of splenectomy in these patients, careful case selection is critical.
Journal
HemaSphere