Togasaki Emi, Shimizu Naomi, Nagao Yuhei, Kawajiri-Manako Chika, Shimizu Ryoh, Oshima-Hasegawa Nagisa, Muto Tomoya, Tsukamoto Shokichi, Mitsukawa Shio, Takeda Yusuke, Mimura Naoya, Ohwada Chikako, Takeuchi Masahiro, Sakaida Emiko, Iseki Tohru, Yoshitomi Hideyuki, Ohtsuka Masayuki, Miyazaki Masaru, Nakaseko Chiaki
Department of Hematology, Chiba University Hospital, 1-8-1 Inohana, Chuo-ku, Chiba, 260-8677, Japan.
Department of Hematology, International University of Health and Welfare School of Medicine, Narita, Japan.
Ann Hematol. 2018 Apr;97(4):655-662. doi: 10.1007/s00277-018-3232-x. Epub 2018 Jan 13.
Thrombopoietin-receptor agonists have been recently introduced for a second-line treatment of immune thrombocytopenia (ITP). Splenectomy has tended to be avoided because of its complications, but the response rate of splenectomy is 60-80% and it has still been considered for steroid-refractory ITP. We performed partial splenic embolization (PSE) as an alternative to splenectomy. Between 1988 and 2013, 91 patients with steroid-resistant ITP underwent PSE at our hospital, and we retrospectively analyzed the efficacy and long-term outcomes of PSE. The complete response rate (CR, platelets > 100 × 10/L) was 51% (n = 46), and the overall response rate (CR plus response (R), > 30 × 10/L) was 84% (n = 76). One year after PSE, 70% of patients remained CR and R. The group with peak platelet count after PSE ≥ 300 × 10/L (n = 29) exhibited a significantly higher platelet count than the group with platelet count < 300 × 10/L (n = 40) at any time point after PSE. The failure-free survival (FFS) rates at 1, 5, and 10 years were 78, 56, and 52%, respectively. Second PSE was performed in 20 patients who relapsed (n = 14) or had no response to the initial PSE (n = 6), and the overall response was achieved in 63% patients. There were no PSE-related deaths. These results indicate that PSE is a safe and effective alternative therapy to splenectomy for patients with steroid-resistant ITP as it generates long-term, durable responses.
血小板生成素受体激动剂最近已被用于免疫性血小板减少症（ITP）的二线治疗。由于脾切除术存在并发症，人们倾向于避免进行该手术，但脾切除术的缓解率为60%-80%，对于类固醇难治性ITP仍会考虑采用。我们进行了部分脾栓塞术（PSE）作为脾切除术的替代方法。1988年至2013年期间，我院91例类固醇难治性ITP患者接受了PSE，我们对PSE的疗效和长期结果进行了回顾性分析。完全缓解率（CR，血小板>100×10⁹/L）为51%（n=46），总体缓解率（CR加反应（R），>30×10⁹/L）为84%（n=76）。PSE后一年，70%的患者维持CR和R。PSE后血小板计数峰值≥300×10⁹/L的组（n=29）在PSE后的任何时间点血小板计数均显著高于血小板计数<300×10⁹/L的组（n=40）。1年、5年和10年的无失败生存率（FFS）分别为78%、56%和52%。20例复发（n=14）或对初始PSE无反应（n=6）的患者进行了第二次PSE，63%的患者实现了总体缓解。没有与PSE相关的死亡病例。这些结果表明，对于类固醇难治性ITP患者，PSE是一种安全有效的脾切除术替代疗法，因为它能产生长期、持久的反应。
