Splenectomy for Children and Adults with Persistent and Chronic Immune Thrombocytopenia: Long term results.

BACKGROUND : Although immune thrombocytopenia (ITP) is a common cause of thrombocytopenia among both children and adults, information regarding prognostic determinants of outcome of splenectomy and the management of patients who fail to respond to splenectomy is limited. AIMS AND OBJECTIVES : To analyze the response to splenectomy and to assess the response to treatment of refractory ITP post splenectomy, in children and adults with persistent and chronic ITP in our institution. METHODOLOGY : All patients with persistent and chronic ITP seen in the Department of Haematology between 1995 and 2009 who underwent splenectomy and whose data could be retrieved were analyzed. RESULTS : Of the 167 adults and 87 children, 82.6% of adults and 88.5% of children were in response at 2 months post splenectomy. After a median follow up of 18.6 months (range:1-170) in adults and 12 months (range: 1-173) in children post splenectomy, 115 (68.9%) adults and 63 (72.4%) children showed a response, while 48 (28.7%) adults & 23 (26.4%) children were refractory to splenectomy. The overall mortality was 6 (3.6%) in adults and 1 (1.2%) in children. Among those who were refractory to splenectomy, subsequent drug treatment resulted in response in additional 25 (15%) of adults and 16 (17.2%) of children. The 5 & 10 year event free survival of total cases were 75.2 ± 3.7% & 71.5 ± 4.5% in adults and 79.1 ± 4.6% & 70 ± 7.5% in children respectively. Among adults, females and those who had higher platelet count at splenectomy had a higher chance of response to splenectomy. While in children, persistent phase of the disease was associated with response. The median time to post splenectomy response was shorter and the median peak platelet count was higher among those who showed sustained response in both groups. CONCLUSION : In this first large series form India, comprehensively analyzing outcome of patients with ITP undergoing splenectomy, the response to treatment is similar to those reported in the literature in both adults and children from other population. Further analysis needs to be done to ascertain the predictive value of the variables associated with response