5-10 year follow-up after splenectomy in immune thrombocytopenic purpura (IIP)
Bronchoalveolar Lavage Fluid
Splenectomy is the only "curative" treatment of ITP. The long-term outcome is uncertain because no series has included a high percentage of all splenectomized patients (pts) nor provided follow-up beyond a median of two years. We performed an IRBapproved study of all cases of ITP that underwent open Splenectomy between 1988 1993 in three major medical centers. Medical information and blood counts were obtained from pts, physicians and/or chart reviews. Criteria for response were: Complete Response (CR): platelet count (pit ct) persistently 150X109/L (150k); Partial Response (PR): all pit cts 50k; Failure: pit cts < 50k. RESULTS: 75 ITP pts underwent Splenectomy during the 6 year period; 56 (75%) were évaluable, with 5-10 year follow up post-op. 45 (80%) were women with a mean age of 39.5 years (range 15-81). Patient's Number of Mean age at Mean time to Therapy Post Outcome Patients Splenectomy Splenectomy(momhs) Splenectomy CR 32(57%) 36 32.8 0 PR 9(16%) 39.6 13.6 5 Failure 15(27%) 43.8 18 15 Total 56 39.5 25.9 20 36 (64%) of pts have never received any therapy post-splenectomy and remain in CR (57%) or PR. Among the 15 Failure pts, 5 pts had had pit cts initially 150k without treatment for 4-6 years prior to relapsing. 3 of the 9 PR pts (with pit cts 50k without treatment) also had late relapses between 4 and 7 yrs postop. 10 (18%) pts reported bleedit g episodes consisting of bruising, ecchymosis and petechiae; there were no major or intern ü hemorrhages. During the 5-10 year follow-up period in the 56 pts, there were no known cases of: sepsis, pneumonia or other life-threatening infections; no myocardial infarction < r significant heart disease; and no new major medical conditions developed. The lack of hea rt disease may be related to 80% of the pts being women with a mean age at last follow-up of 46.4 yrs; only 2 males had surgery after age 50. Conclusion: Long term follow-up 5-10 yea 's after splenectomy in FTP has shown that: 1 ) the long term CR rate is 57% with a 64% rate < f a stable pit ct 50k not requiring therapy; 2) 8 pts suffered a relapse, after appearing to 1 e in CR or PR, 4-7 years post splenectomy illustrating the need for a minimum 5 year followi p in assessing outcome, and 3) splenectomy appears to have a minimum of significant longteri n adverse effects.