PB1210 - Safety and efficacy of splenectomy for the treatment of chronic immune thrombocytopenia (ITP).

Tuesday, July 12, 2022

6:30 PM – 7:30 PM

Location: Exhibition

Presentation Format: In-Person

Presenting Author(s)

Artur Saldanha, MD

Thrombosis and Hemostasis fellow
Hospital das Clinicas of the University of Sao Paulo Medical School
São Paulo, Sao Paulo, Brazil

Co-Author(s)

FO

Fernanda A. Orsi

Assistant Physician
Clinics Hospital of the University of São Paulo Medical School
São Paulo, Sao Paulo, Brazil
EO

Erica Okazaki

Hematologist
Clinics Hospital of the University of São Paulo Medical School
São Paulo, Sao Paulo, Brazil
CR

Cynthia Rothschild

Hematologist
ICESP - University of São Paulo Medical School
São Paulo, Sao Paulo, Brazil
PP

Paula Prestes

Assistant Physician
Clinics Hospital of the University of São Paulo Medical School
São Paulo, Sao Paulo, Brazil
BS

Bianca Stefanello

Hematologist
Clinics Hospital of the University of São Paulo Medical School
São Paulo, Sao Paulo, Brazil
LA

Lucas Alves

Biostatician
Clinics Hospital of the University of São Paulo Medical School
São Paulo, Sao Paulo, Brazil
VR

Vanderson Rocha

Hematologist
Clinics Hospital of the University of São Paulo Medical School
São Paulo, Sao Paulo, Brazil
PV

Paula R. Villaça

Hematologist
Clinics Hospital of the University of São Paulo Medical School
São Paulo, Sao Paulo, Brazil

Background: Although splenectomy has high rates of durable response, its indication has decreased due to concerns on short and long-term complications.

Aims: To evaluate the short/long-term safety and efficacy of splenectomy for chronic ITP treatment.

Methods: A cohort of ITP patients who underwent splenectomy was included and followed for up to 10 years. Descriptive analyses of complications (related to the procedure, infections, and thrombosis) and response to treatment were performed.

Results: Out of 87 patients included, 80.5% were women, the median age at diagnosis was 33 years (IQR 24 – 50), 28.7% had hypertension and 20.7% had antiphospholipid antibodies. Median time from diagnosis to splenectomy was 19 months (IQR 6.0 – 50.0) and of follow-up duration, 61 months (27 – 108). Post-procedure complications, such as fistula, surgical site infection and bleeding requiring transfusion, occurred in 6 (7%) patients and hospital-associated thrombosis (thrombosis occurring within 90 days after splenectomy) in 3 (3.4%). Two patients had abdominal thrombosis and 1 had abdominal and deep vein thrombosis. During follow-up, 3 patients had infections requiring hospitalization, resulting in a 5-year cumulative risk of infections of 3.4% (0.9 – 9.1) (Table1). Sixty days after splenectomy, 72 patients (82.5%) had an overall response, of which 55 were complete (63.2%) and 17 partial responses (19.3%). Median time for relapse was 12.5 months (IQR 4 - 45.3) and the 5-year treatment free survival was 55.3% (95%CI 45.8 – 66.4) (Figure1). At the end of the follow-up, 77 patients (88.5%) had partial or complete response and 2 (2.3%) had died.

Conclusion(s): Splenectomy is an efficacious well-tolerated treatment. The response rate is high, even for those requiring further ITP treatment, suggesting that splenectomy modulates future therapy response. In conclusion, splenectomy-associated rates of efficacy outweigh its rates of complications, which underscores that splenectomy should be regarded as one of the main approach for long-term ITP remission.