Splenectomy as a curative treatment for immune thrombocytopenia: a retrospective analysis of 233 patients with a minimum follow up of 10 years

Background. The treatment of choice in steroid-resistant ITP is still controversial, due to the recent advent of new drugs (anti-CD20 and thrombopoietin mimetics) which have encouraged a generalized tendency to delay splenectomy. Consequently, the importance to define the efficacy and safety of splenectomy in the long-term is substantial. Patients and Methods. We retrospectively analyzed the data of 233 ITP patients who underwent splenectomy between 1959 and 2001, in 6 different European hematological Institutions and have now a minimum follow-up of 10 years from surgery. Results. Of the 233 patients, 206 (88%) achieved a response (87% complete). Sixty-eight out of 206 (33%) responsive patients relapsed, mostly (75%) within 4 years from first response. In 92 patients (39.5%), further treatment was required after splenectomy, which was effective in 76 cases (83%). In 138 patients (59%) response was maintained, free of any treatment, at last contact. No significant association between baseline characteristics and likelihood of stable response was found. Overall, 73 (31%) and 58 (25%) patients experienced at least one infectious or hemorrhagic complication. A stable response to splenectomy was associated with a lower rate of infectious (p=0.004) and hemorrhages (p<0.0001). Thrombosis developed in 18 patients (8%). Conclusions. Splenectomy is an effective treatment for ITP, curative in around 60% of the patients. Long-term complications mainly affected non-responding patients and were fatal in a minority of the cases. The identification of baseline features, able to discriminate those patients at higher probability to achieve a stable response, is essential for a proper selection of optimal candidates to splenectomy.