SHORT AND LONG-TERM OUTCOMES OF SPLENECTOMY AND SURGICAL COMPLICATIONS IN PATIENTS WITH IMMUNE THROMBOCYTOPENIC PURPURA (ITP) IN A SINGLE CENTER IN ALGERIA
(Abstract release date: 05/19/16)
EHA Library. Abad M. 06/09/16; 134977; PB2077
Mohand Abad
Contributions
Contributions
Abstract
Abstract: PB2077
Type: Publication Only
Background
Among several treatment of immune thrombocytopenic purpura, glucocorticoides are the first one resulting in a high rate of response; unfortunately most patients (pts) responding to this treatment fail to maintain durable response. Splenectomy, the second line treatment produces an important rate of durable responses, about 60-80%.
Aims
To report and evaluate the short and the long-term outcomes and surgical complications in adults and children with ITP who underwent splenectomy.
Methods
We rewieved the medical records of 142 pts who underwent splenectomy for ITP from 1987-2014. Response was defined as : complete response (CR) : platelet count>100000/µl ; partial response (PR) : platelet count > 50000/µl, no response (NR) or failure: platelet count < 50000/µl, relapse : loss of CR.142 patients were splenectomized : 44 males (31%) and 98 females (69%),Sex ratio = 0,45.Median âge at diagnosis was 26,8 years (2-71); there were 101 adults and 41childreen .Median âge at splenectomy was 28,8 years (5-72). At the time of splenectomy, 31 pts were childreen (29%) and 111 were adults. 71 (50%) were splenectomized because they were corticostreroid dependency and 50% because they failed to corticosteroids. The median time from diagnosis to splenectomy was 25,1 months (2-156) The median platelet count at diagnosis was 27000/µl and the median preoperative platelet count was 60000/µl.
Results
Before splenectomy,134 pts(94,3%) received only steroids at initial treatment. 139 pts were vaccinated (pneumococcal vaccine) before splenectomy and after it. In pts with severe thrombocytopenia intravenous corticosteroids were done in 33 cases(23,2%).Laparoscopic splenectomy was performed in 54 pts and open splenectomy in 88 cases.In the post operative period, we noted wound infection in one case; 3 cases requiring open surgery because intra abdominal hemorrhage, one death resulting from neurological disorder related to adrenal insufficiency. Accessory spleen was removed in one patient. Prophylactic antibiotic therapy was systematic during the 2 first years. For 136 informative pts : the median follow up after splenectomy was 80,1 months.Good responses (CR+PR) was achieved at month 1 for 127 (89,4%) of pts : CR : 118 (83%),PR : 09 (6,3%) whereas the remaining (09) were refractory to splenectomy. After 1 year : 125 pts followed : 95 CR, 4 PR, 9 NR. After 2 years : 114 pts followed : 89 CR, 2 PR, 7 NR. Relapses are encountered in 24 (16,9%) pts with an median time of 28,6 months. 21 of these pts were treated, resulting of 12 CR, 03 PR and 06 steroids dependency (one was reoperated for an accessory spleen for relapse 4 years after the first splenectomy). Among the failures, a multiple myeloma apparead 43 months after the ITP ; In one case, the histological study revealed a non hodgkin lymphoma; the ITP has preceded an autoimmune disease in 4 cases (an autoimmune hemolytic anemia after 62 months, 2 cases of systemic lupus erythematous respectively after 42 and 100 months and 1 case of Biermer’s anemia 128 months after the ITP) ; 2 cases of family ITP (one pt splenectomized and her daughter followed for ITP that preceded rheumatoid arthritis,2 sisters splenectomized have died, one in operative period by fatal h.emorrhage and the second 151 months after splenectomy after relapse as Evans syndrome.The median total follow up of the 142 patients was 103 months.
Conclusion
Our study documents that splenectomy si an effective treatment for ITP by the frequency of RC, the excellent outcomes of this procedure for patients with ITP and the mortality rate decreased. However predictive factors of success remain to be clarified.
Session topic: E-poster
Keyword(s): Idiopathic thombocytopenic purpura (ITP), Splenectomy
Type: Publication Only
Background
Among several treatment of immune thrombocytopenic purpura, glucocorticoides are the first one resulting in a high rate of response; unfortunately most patients (pts) responding to this treatment fail to maintain durable response. Splenectomy, the second line treatment produces an important rate of durable responses, about 60-80%.
Aims
To report and evaluate the short and the long-term outcomes and surgical complications in adults and children with ITP who underwent splenectomy.
Methods
We rewieved the medical records of 142 pts who underwent splenectomy for ITP from 1987-2014. Response was defined as : complete response (CR) : platelet count>100000/µl ; partial response (PR) : platelet count > 50000/µl, no response (NR) or failure: platelet count < 50000/µl, relapse : loss of CR.142 patients were splenectomized : 44 males (31%) and 98 females (69%),Sex ratio = 0,45.Median âge at diagnosis was 26,8 years (2-71); there were 101 adults and 41childreen .Median âge at splenectomy was 28,8 years (5-72). At the time of splenectomy, 31 pts were childreen (29%) and 111 were adults. 71 (50%) were splenectomized because they were corticostreroid dependency and 50% because they failed to corticosteroids. The median time from diagnosis to splenectomy was 25,1 months (2-156) The median platelet count at diagnosis was 27000/µl and the median preoperative platelet count was 60000/µl.
Results
Before splenectomy,134 pts(94,3%) received only steroids at initial treatment. 139 pts were vaccinated (pneumococcal vaccine) before splenectomy and after it. In pts with severe thrombocytopenia intravenous corticosteroids were done in 33 cases(23,2%).Laparoscopic splenectomy was performed in 54 pts and open splenectomy in 88 cases.In the post operative period, we noted wound infection in one case; 3 cases requiring open surgery because intra abdominal hemorrhage, one death resulting from neurological disorder related to adrenal insufficiency. Accessory spleen was removed in one patient. Prophylactic antibiotic therapy was systematic during the 2 first years. For 136 informative pts : the median follow up after splenectomy was 80,1 months.Good responses (CR+PR) was achieved at month 1 for 127 (89,4%) of pts : CR : 118 (83%),PR : 09 (6,3%) whereas the remaining (09) were refractory to splenectomy. After 1 year : 125 pts followed : 95 CR, 4 PR, 9 NR. After 2 years : 114 pts followed : 89 CR, 2 PR, 7 NR. Relapses are encountered in 24 (16,9%) pts with an median time of 28,6 months. 21 of these pts were treated, resulting of 12 CR, 03 PR and 06 steroids dependency (one was reoperated for an accessory spleen for relapse 4 years after the first splenectomy). Among the failures, a multiple myeloma apparead 43 months after the ITP ; In one case, the histological study revealed a non hodgkin lymphoma; the ITP has preceded an autoimmune disease in 4 cases (an autoimmune hemolytic anemia after 62 months, 2 cases of systemic lupus erythematous respectively after 42 and 100 months and 1 case of Biermer’s anemia 128 months after the ITP) ; 2 cases of family ITP (one pt splenectomized and her daughter followed for ITP that preceded rheumatoid arthritis,2 sisters splenectomized have died, one in operative period by fatal h.emorrhage and the second 151 months after splenectomy after relapse as Evans syndrome.The median total follow up of the 142 patients was 103 months.
Conclusion
Our study documents that splenectomy si an effective treatment for ITP by the frequency of RC, the excellent outcomes of this procedure for patients with ITP and the mortality rate decreased. However predictive factors of success remain to be clarified.
Session topic: E-poster
Keyword(s): Idiopathic thombocytopenic purpura (ITP), Splenectomy
Abstract: PB2077
Type: Publication Only
Background
Among several treatment of immune thrombocytopenic purpura, glucocorticoides are the first one resulting in a high rate of response; unfortunately most patients (pts) responding to this treatment fail to maintain durable response. Splenectomy, the second line treatment produces an important rate of durable responses, about 60-80%.
Aims
To report and evaluate the short and the long-term outcomes and surgical complications in adults and children with ITP who underwent splenectomy.
Methods
We rewieved the medical records of 142 pts who underwent splenectomy for ITP from 1987-2014. Response was defined as : complete response (CR) : platelet count>100000/µl ; partial response (PR) : platelet count > 50000/µl, no response (NR) or failure: platelet count < 50000/µl, relapse : loss of CR.142 patients were splenectomized : 44 males (31%) and 98 females (69%),Sex ratio = 0,45.Median âge at diagnosis was 26,8 years (2-71); there were 101 adults and 41childreen .Median âge at splenectomy was 28,8 years (5-72). At the time of splenectomy, 31 pts were childreen (29%) and 111 were adults. 71 (50%) were splenectomized because they were corticostreroid dependency and 50% because they failed to corticosteroids. The median time from diagnosis to splenectomy was 25,1 months (2-156) The median platelet count at diagnosis was 27000/µl and the median preoperative platelet count was 60000/µl.
Results
Before splenectomy,134 pts(94,3%) received only steroids at initial treatment. 139 pts were vaccinated (pneumococcal vaccine) before splenectomy and after it. In pts with severe thrombocytopenia intravenous corticosteroids were done in 33 cases(23,2%).Laparoscopic splenectomy was performed in 54 pts and open splenectomy in 88 cases.In the post operative period, we noted wound infection in one case; 3 cases requiring open surgery because intra abdominal hemorrhage, one death resulting from neurological disorder related to adrenal insufficiency. Accessory spleen was removed in one patient. Prophylactic antibiotic therapy was systematic during the 2 first years. For 136 informative pts : the median follow up after splenectomy was 80,1 months.Good responses (CR+PR) was achieved at month 1 for 127 (89,4%) of pts : CR : 118 (83%),PR : 09 (6,3%) whereas the remaining (09) were refractory to splenectomy. After 1 year : 125 pts followed : 95 CR, 4 PR, 9 NR. After 2 years : 114 pts followed : 89 CR, 2 PR, 7 NR. Relapses are encountered in 24 (16,9%) pts with an median time of 28,6 months. 21 of these pts were treated, resulting of 12 CR, 03 PR and 06 steroids dependency (one was reoperated for an accessory spleen for relapse 4 years after the first splenectomy). Among the failures, a multiple myeloma apparead 43 months after the ITP ; In one case, the histological study revealed a non hodgkin lymphoma; the ITP has preceded an autoimmune disease in 4 cases (an autoimmune hemolytic anemia after 62 months, 2 cases of systemic lupus erythematous respectively after 42 and 100 months and 1 case of Biermer’s anemia 128 months after the ITP) ; 2 cases of family ITP (one pt splenectomized and her daughter followed for ITP that preceded rheumatoid arthritis,2 sisters splenectomized have died, one in operative period by fatal h.emorrhage and the second 151 months after splenectomy after relapse as Evans syndrome.The median total follow up of the 142 patients was 103 months.
Conclusion
Our study documents that splenectomy si an effective treatment for ITP by the frequency of RC, the excellent outcomes of this procedure for patients with ITP and the mortality rate decreased. However predictive factors of success remain to be clarified.
Session topic: E-poster
Keyword(s): Idiopathic thombocytopenic purpura (ITP), Splenectomy
Type: Publication Only
Background
Among several treatment of immune thrombocytopenic purpura, glucocorticoides are the first one resulting in a high rate of response; unfortunately most patients (pts) responding to this treatment fail to maintain durable response. Splenectomy, the second line treatment produces an important rate of durable responses, about 60-80%.
Aims
To report and evaluate the short and the long-term outcomes and surgical complications in adults and children with ITP who underwent splenectomy.
Methods
We rewieved the medical records of 142 pts who underwent splenectomy for ITP from 1987-2014. Response was defined as : complete response (CR) : platelet count>100000/µl ; partial response (PR) : platelet count > 50000/µl, no response (NR) or failure: platelet count < 50000/µl, relapse : loss of CR.142 patients were splenectomized : 44 males (31%) and 98 females (69%),Sex ratio = 0,45.Median âge at diagnosis was 26,8 years (2-71); there were 101 adults and 41childreen .Median âge at splenectomy was 28,8 years (5-72). At the time of splenectomy, 31 pts were childreen (29%) and 111 were adults. 71 (50%) were splenectomized because they were corticostreroid dependency and 50% because they failed to corticosteroids. The median time from diagnosis to splenectomy was 25,1 months (2-156) The median platelet count at diagnosis was 27000/µl and the median preoperative platelet count was 60000/µl.
Results
Before splenectomy,134 pts(94,3%) received only steroids at initial treatment. 139 pts were vaccinated (pneumococcal vaccine) before splenectomy and after it. In pts with severe thrombocytopenia intravenous corticosteroids were done in 33 cases(23,2%).Laparoscopic splenectomy was performed in 54 pts and open splenectomy in 88 cases.In the post operative period, we noted wound infection in one case; 3 cases requiring open surgery because intra abdominal hemorrhage, one death resulting from neurological disorder related to adrenal insufficiency. Accessory spleen was removed in one patient. Prophylactic antibiotic therapy was systematic during the 2 first years. For 136 informative pts : the median follow up after splenectomy was 80,1 months.Good responses (CR+PR) was achieved at month 1 for 127 (89,4%) of pts : CR : 118 (83%),PR : 09 (6,3%) whereas the remaining (09) were refractory to splenectomy. After 1 year : 125 pts followed : 95 CR, 4 PR, 9 NR. After 2 years : 114 pts followed : 89 CR, 2 PR, 7 NR. Relapses are encountered in 24 (16,9%) pts with an median time of 28,6 months. 21 of these pts were treated, resulting of 12 CR, 03 PR and 06 steroids dependency (one was reoperated for an accessory spleen for relapse 4 years after the first splenectomy). Among the failures, a multiple myeloma apparead 43 months after the ITP ; In one case, the histological study revealed a non hodgkin lymphoma; the ITP has preceded an autoimmune disease in 4 cases (an autoimmune hemolytic anemia after 62 months, 2 cases of systemic lupus erythematous respectively after 42 and 100 months and 1 case of Biermer’s anemia 128 months after the ITP) ; 2 cases of family ITP (one pt splenectomized and her daughter followed for ITP that preceded rheumatoid arthritis,2 sisters splenectomized have died, one in operative period by fatal h.emorrhage and the second 151 months after splenectomy after relapse as Evans syndrome.The median total follow up of the 142 patients was 103 months.
Conclusion
Our study documents that splenectomy si an effective treatment for ITP by the frequency of RC, the excellent outcomes of this procedure for patients with ITP and the mortality rate decreased. However predictive factors of success remain to be clarified.
Session topic: E-poster
Keyword(s): Idiopathic thombocytopenic purpura (ITP), Splenectomy
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