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Article Dans Une Revue Annals of Surgery Année : 2016

Reemergence of Splenectomy for ITP Second-line Treatment?

Louis Terriou
  • Fonction : Auteur
David Launay
  • Fonction : Auteur
P Chambon Jean
  • Fonction : Auteur
Francois Provot
  • Fonction : Auteur
Moshe Rogosnitzky
  • Fonction : Auteur
Philippe Zerbib
  • Fonction : Auteur

Résumé

Introduction: Corticosteroids are still the standard first-line treatment for immune thrombocytopenic purpura (ITP). As second-line therapy, splenectomy and Rituximab are both recommended. The aim of our study was to compare the efficacy of Rituximab to splenectomy in persistent or chronic ITP patients. Methods: Between January 1999 and March 2015, we retrospectively selected all consecutive patients who underwent an ITP second-line treatment: Rituximab or splenectomy. The distinction between open (OS) and laparoscopic splenectomy (LS) was analyzed. Primary outcome was composite: hospitalization for bleeding and/or thrombocytopenia and death from hemorrhage or infection. Secondary outcomes were based on response (R) and complete response (CR) rates as defined by the American Society of Hematology. Results: Ninety-six patients were included: 30 patients received Rituximab, 37 underwent OS, and 29 underwent LS. The follow-up was 30, 60, and 120 months in Rituximab, LS, and OS groups, respectively. At 30th month, the primary outcome-free survival rate was higher in splenectomy groups (84% for OS, 86% for LS) than Rituximab group (47%) (P = 0.0002). Similarly, at 30th month, R and CR rates were higher for OS (86.5% and 75.7%, respectively) and LS groups (93.1% and 89.7%) than Rituximab (46.7% and 30%) (P = 0.0001). Moreover, R rates remained elevated at 60th month for OS and LS groups (83.7% and 89.6% respectively) and 78.4% at 120th month for OS group. Conclusion: We observed that splenectomy for ITP second-line treatment was more effective than Rituximab regarding maintenance of R, CR, and overall response rates. OS and LS had similar efficacy.
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Dates et versions

hal-03782646 , version 1 (21-09-2022)

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Citer

Charbel Chater, Louis Terriou, Alain Duhamel, David Launay, P Chambon Jean, et al.. Reemergence of Splenectomy for ITP Second-line Treatment?. Annals of Surgery, 2016, Annals of surgery, 264 (5), pp.772-777. ⟨10.1097/SLA.0000000000001912⟩. ⟨hal-03782646⟩
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