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Splenectomy for Immune Thrombocytopenia: Down but not out

Shruti Chaturvedi, Donald M/ Arnold and Keith R. McCrae

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  • Splenectomy for immune thrombocytopenia: last but not least.
    • Charbel CHATER, Surgeon CHU Lille
    • Other Contributors:
      • Philippe ZERBIB, Surgeon

    Chaturvedi S. et al published an important contribution to surgical literature by assessing role of splenectomy in immune thrombocytopenia (ITP)(1). International guidelines recommend splenectomy as a second-line treatment, but do not state preference between splenectomy, rituximab or TPO-Ras due to absence of randomized-controlled-trials. When patients are supposedly being given a choice between surgical and medical treatment, it is in fact rare that they choose surgery as first option. So, randomization seems difficult to achieve.
    We have recently reported the long-term results of splenectomy compared to efficacy of rituximab in persistent or chronic ITP-patients(2). We observed that splenectomy was more effective than rituximab regarding maintenance of response (R), complete response (CR) and overall response rates (Table 1). Our study matches the results of a propensity score-adjusted French study(3).
    Splenectomy continues to have bad character of excessively risky treatment (postoperative thrombosis and encapsuled-bacterial infection). Probably formerly overestimated, these risks have been considerably reduced in the meantime to an incidence of 0.5% per year. We did not observe any serious life-threatening infection 10 years after splenectomy and mortality was nil. At the same time, risk of infection for patients treated by rituximab or TPO-Ras exists, and their long-term effect on immunity remains unclear.
    Splenectomy is an old treatment but, preope...

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    Conflict of Interest:
    None declared.