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)
1
CHU Henri Mondor [Créteil]
2 AP-HP - Hôpital Bichat - Claude Bernard [Paris]
3 CeReCAI - Centre de référence des cytopénies auto-immunes [CHU Mondor]
4 UPEC UP12 - Université Paris-Est Créteil Val-de-Marne - Paris 12
5 CHRU Lille - Centre Hospitalier Régional Universitaire [CHU Lille]
6 INFINITE (Ex-Liric) - Institute for Translational Research in Inflammation - U 1286
7 TIMONE - Hôpital de la Timone [CHU - APHM]
8 AMU - Aix Marseille Université
9 CHU de Poitiers - Centre hospitalier universitaire de Poitiers = Poitiers University Hospital
10 CRCINA-ÉQUIPE 7 - Innate Immunity and Immunotherapy
11 CHU Angers - Centre Hospitalier Universitaire d'Angers
12 FHU GOAL - Fédérations hospitalo-universitaires Grand Ouest Acute Leukemia [Angers]
13 Centre hospitalier de Saint-Nazaire
14 CHLS - Centre Hospitalier Lyon Sud [CHU - HCL]
15 CHU Estaing [Clermont-Ferrand]
16 Hôpital Haut-Lévêque [CHU Bordeaux]
17 IHBN - Institut d'Hématologie de Basse-Normandie
18 CHU Caen
19 CHU Dijon
20 UB - Université de Bourgogne
21 Hôpital Sud [CHU Rennes]
22 CHU Saint-Antoine [AP-HP]
23 Hôpital Cochin [AP-HP]
24 Hôpital l'Archet
25 UniCA - Université Côte d'Azur
26 CHU Nice - Centre Hospitalier Universitaire de Nice
27 CHU Amiens-Picardie
28 IUCT Oncopole - UMR 1037 - Institut Universitaire du Cancer de Toulouse - Oncopole
29 CHU Toulouse - Centre Hospitalier Universitaire de Toulouse
2 AP-HP - Hôpital Bichat - Claude Bernard [Paris]
3 CeReCAI - Centre de référence des cytopénies auto-immunes [CHU Mondor]
4 UPEC UP12 - Université Paris-Est Créteil Val-de-Marne - Paris 12
5 CHRU Lille - Centre Hospitalier Régional Universitaire [CHU Lille]
6 INFINITE (Ex-Liric) - Institute for Translational Research in Inflammation - U 1286
7 TIMONE - Hôpital de la Timone [CHU - APHM]
8 AMU - Aix Marseille Université
9 CHU de Poitiers - Centre hospitalier universitaire de Poitiers = Poitiers University Hospital
10 CRCINA-ÉQUIPE 7 - Innate Immunity and Immunotherapy
11 CHU Angers - Centre Hospitalier Universitaire d'Angers
12 FHU GOAL - Fédérations hospitalo-universitaires Grand Ouest Acute Leukemia [Angers]
13 Centre hospitalier de Saint-Nazaire
14 CHLS - Centre Hospitalier Lyon Sud [CHU - HCL]
15 CHU Estaing [Clermont-Ferrand]
16 Hôpital Haut-Lévêque [CHU Bordeaux]
17 IHBN - Institut d'Hématologie de Basse-Normandie
18 CHU Caen
19 CHU Dijon
20 UB - Université de Bourgogne
21 Hôpital Sud [CHU Rennes]
22 CHU Saint-Antoine [AP-HP]
23 Hôpital Cochin [AP-HP]
24 Hôpital l'Archet
25 UniCA - Université Côte d'Azur
26 CHU Nice - Centre Hospitalier Universitaire de Nice
27 CHU Amiens-Picardie
28 IUCT Oncopole - UMR 1037 - Institut Universitaire du Cancer de Toulouse - Oncopole
29 CHU Toulouse - Centre Hospitalier Universitaire de Toulouse
Corentin Orvain
- Fonction : Auteur
- PersonId : 775693
- ORCID : 0000-0002-8717-0824
Jean‐christophe Lega
- Fonction : Auteur
- PersonId : 772300
- IdHAL : jean-christophe-lega
- ORCID : 0000-0002-9398-2968
Antoine Dossier
- Fonction : Auteur
- PersonId : 778691
- ORCID : 0000-0002-2008-2942
Bernard Bonnotte
- Fonction : Auteur
- PersonId : 766701
- ORCID : 0000-0001-7229-3808
Amandine Dernoncourt
- Fonction : Auteur
- PersonId : 1155193
- ORCID : 0000-0002-7469-0492
- IdRef : 249640317
Thibault Comont
- Fonction : Auteur
- PersonId : 804754
- ORCID : 0000-0002-6891-9238
Résumé
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.