Andrew Love Cancer Centre, University Hospital Geelong, Geelong, Victoria, Australia.
Deakin University, Department of Medicine, Geelong, Victoria, Australia.
Intern Med J. 2022 Aug;52(8):1387-1393. doi: 10.1111/imj.15344. Epub 2022 May 31.
Splenectomy is an effective intervention in primary immune thrombocytopenia (ITP). Attempts to define pre-clinical predictors of platelet response to splenectomy are inconsistent. Based on international studies defining the likelihood of platelet response using platelet sequestration, patients with relapsed/refractory ITP being considered for splenectomy at a regional Australian hospital were assessed with indium-labelled autologous platelet sequestration (ILAPS) studies.
To audit the use of ILAPS in an Australian setting and define its role in predicting response to splenectomy.
A retrospective review of all patients referred for an ILAPS study at a regional hospital was performed. Results for each patient were expressed as an 'R' value (spleen/ liver uptake ratio) to quantify the platelet sequestration pattern and outcome post-splenectomy, based on platelet counts.
A total of 45 patients was identified: 13 underwent splenectomy and 32 were medically managed. Patients with favourable ILAPS scans (pure or predominant splenic sequestration) demonstrated a superior response post-splenectomy (100% overall response rate (ORR); 83.5% complete remission (CR)) compared with those with unfavourable ILAPS scans (mixed or pure hepatic sequestration) (71.4% ORR; 57.1% CR) over 12 months.
The use of ILAPS in the Australian setting is feasible and this experience confirms larger international studies demonstrating its utility as a predictor of response to splenectomy in ITP. An unfavourable ILAPS scan could be considered a negative predictor of response prompting consideration for other emerging ITP treatments such as thrombopoietin-receptor agonists or B-cell depleting therapy such as Rituximab.
脾切除术是治疗原发免疫性血小板减少症（ITP）的有效干预措施。尝试定义脾切除术后血小板反应的临床前预测因子的结果并不一致。基于使用血小板隔离来定义血小板反应可能性的国际研究，对在澳大利亚一家地区医院考虑行脾切除术的复发/难治性 ITP 患者进行了铟标记自身血小板隔离（ILAPS）研究。
在澳大利亚环境中评估 ILAPS 的使用情况，并确定其在预测脾切除术后反应中的作用。
对一家地区医院转诊进行 ILAPS 研究的所有患者进行了回顾性审查。根据血小板计数，将每位患者的结果表示为“R”值（脾脏/肝脏摄取比值），以量化血小板隔离模式和脾切除术后的结果。
共确定了 45 例患者：13 例接受了脾切除术，32 例接受了药物治疗。具有有利 ILAPS 扫描（纯或主要脾脏隔离）的患者在脾切除术后表现出更好的反应（总反应率（ORR）为 100%；完全缓解（CR）率为 83.5%），而具有不利 ILAPS 扫描（混合或纯肝脏隔离）的患者在 12 个月时的 ORR 为 71.4%（CR 率为 57.1%）。
在澳大利亚环境中使用 ILAPS 是可行的，这一经验证实了更大规模的国际研究表明其作为 ITP 脾切除术后反应预测因子的实用性。不利的 ILAPS 扫描可被视为反应不良的预测因子，促使考虑其他新兴的 ITP 治疗方法，如血小板生成素受体激动剂或 B 细胞耗竭治疗，如利妥昔单抗。
