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Splenectomy for primary immune thrombocytopenia revisited in the era of thrombopoietin receptor agonists: New insights for an old treatment

Arthur Mageau 1, 2, 3, 4 Louis Terriou 5, 6 Mikael Ebbo 7, 8 Odile Souchaud‐debouverie 9 Corentin Orvain 10, 11, 12 Julie Graveleau 13 Jean‐christophe Lega 14 Marc Ruivard 15 Jean‐françois Viallard 16 Stéphane Cheze 17, 18 Antoine Dossier 2 Bernard Bonnotte 19, 20 Antoinette Perlat 21 Delphine Gobert 22 Nathalie Costedoat‐chalumeau 23 Pierre‐yves Jeandel 24, 25, 26 Amandine Dernoncourt 27 Marc Michel 1, 3 Bertrand Godeau 1, 3 Thibault Comont 28, 29 
Abstract : Although splenectomy is still considered the most effective curative treatment for immune thrombocytopenia (ITP), its use has significantly declined in the last decade, especially since the approval of thrombopoietin receptor agonists (TPO-RAs). The main objective of the study was to determine whether splenectomy was still as effective nowadays, particularly for patients with failure to respond to TPO-RAs. Our secondary objective was to assess, among patients who relapsed after splenectomy, the pattern of response to treatments used before splenectomy. This multicenter retrospective study involved adults who underwent splenectomy for ITP in France from 2011 to 2020. Response status was defined according to international criteria. We included 185 patients, 100 (54.1%) and 135 (73.0%) patients had received TPO-RAs and/or rituximab before the splenectomy. The median follow-up after splenectomy was 39.2 months [16.5-63.0]. Overall, 144 (77.8%) patients had an initial response and 23 (12.4%) experienced relapse during follow-up, for an overall sustained response of 65.4%, similar to that observed in the pre-TPO-RA era. Among patients who received at least one TPO-RA or rituximab before splenectomy, 92/151 (60.9%) had a sustained response. Six of 13 (46%) patients with previous lack of response to both TPO-RAs and rituximab had a sustained response to splenectomy. Among patients with relapse after splenectomy, 13/21 (61.2%) patients responded to one TPO-RAs that failed before splenectomy. In conclusion, splenectomy is still a relevant option for treating adult primary ITP not responding to TPO-RAs and rituximab. Patients with lack of response or with relapse after splenectomy should be re-challenged with TPO-RAs.
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Submitted on : Friday, January 28, 2022 - 11:54:00 AM
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Arthur Mageau, Louis Terriou, Mikael Ebbo, Odile Souchaud‐debouverie, Corentin Orvain, et al.. Splenectomy for primary immune thrombocytopenia revisited in the era of thrombopoietin receptor agonists: New insights for an old treatment. American Journal of Hematology, Wiley, 2022, 97 (1), pp.10-17. ⟨10.1002/ajh.26378⟩. ⟨inserm-03547101⟩



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