Absolute lymphocyte count is a predictor of outcome after splenectomy for immune thrombocytopenia
Journal Title: Gulhane Medical Journal - Year 2020, Vol 62, Issue 2
Abstract
Aims: Splenectomy is still the standard salvage therapy in immune thrombocytopenia (ITP) cases refractory to corticosteroid therapy. The aim of this study was to evaluate adult ITP patients who underwent splenectomy and to analyze the predictive factors of response to splenectomy. Methods: A retrospective analysis was performed from 2009 to 2018 using the data of 46 patients with ITP who underwent splenectomy in our hospital. The diagnosis and response to treatment were evaluated according to the International Working Group recommendations. A complete response (CR) was accepted as any platelet count >100×109/L. A partial response (PR) was accepted as any platelet count from 30-100×109/L or a doubling of basal platelet count. Results: After splenectomy, 38/46 (82.7%) patients achieved CR and 6/46 (13.0%) achieved PR. Fifteen (34.0%) responders relapsed with a median time of 61.9 months. Compared to the non-responders and relapsed patients (NR + relapsed, n=17), the stable responders (CR + PR, n=29) had lower absolute lymphocyte count (ALC) (ALC, ×109/L) at the time of diagnosis [1.8 (0.84-4.32) vs 2.47 (1.4-5.1); p=0.018]. Patients with ALC ≤1.85×109/L at the time of diagnosis had a better response to splenectomy to splenectomy than those with ALC >1.85×109/L (p=0.031). According to the Cox-Regression module, we demonstrated that the increase in initial ALC would increase the relapse rate after splenectomy (Hazard ratio: 1.003, 95% confidence interval: 1.001-1.005; p=0.009). Conclusions: Splenectomy is a safe treatment with a long-term CR rate of 58.6% for ITP patients. The findings highlighted that ALC at the time of diagnosis was the only predictive variable of long-term response to splenectomy in patients with ITP.
Authors and Affiliations
Abdulkerim Yıldız, Murat Albayrak, Çiğdem Pala, Osman Şahin, Arif Kuş, Senem Maral, Pınar Cömert, Hacer Berna Afacan Öztürk
Keywords
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