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在血小板生成素受体激动剂时代重新审视脾切除术治疗原发性免疫性血小板减少症:一种古老治疗方法的新见解。

Splenectomy for primary immune thrombocytopenia revisited in the era of thrombopoietin receptor agonists: New insights for an old treatment.

机构信息

Service de Médecine Interne, CHU Henri-Mondor, Assistance Publique-Hôpitaux de Paris, Université Paris Est Créteil, Créteil, France.

Service de Médecine Interne, Hôpital Bichat, APHP, Paris, France.

出版信息

Am J Hematol. 2022 Jan 1;97(1):10-17. doi: 10.1002/ajh.26378. Epub 2021 Oct 26.

Abstract

Although splenectomy is still considered the most effective curative treatment for immune thrombocytopenia (ITP), its use has significantly declined in the last decade, especially since the approval of thrombopoietin receptor agonists (TPO-RAs). The main objective of the study was to determine whether splenectomy was still as effective nowadays, particularly for patients with failure to respond to TPO-RAs. Our secondary objective was to assess, among patients who relapsed after splenectomy, the pattern of response to treatments used before splenectomy. This multicenter retrospective study involved adults who underwent splenectomy for ITP in France from 2011 to 2020. Response status was defined according to international criteria. We included 185 patients, 100 (54.1%) and 135 (73.0%) patients had received TPO-RAs and/or rituximab before the splenectomy. The median follow-up after splenectomy was 39.2 months [16.5-63.0]. Overall, 144 (77.8%) patients had an initial response and 23 (12.4%) experienced relapse during follow-up, for an overall sustained response of 65.4%, similar to that observed in the pre-TPO-RA era. Among patients who received at least one TPO-RA or rituximab before splenectomy, 92/151 (60.9%) had a sustained response. Six of 13 (46%) patients with previous lack of response to both TPO-RAs and rituximab had a sustained response to splenectomy. Among patients with relapse after splenectomy, 13/21 (61.2%) patients responded to one TPO-RAs that failed before splenectomy. In conclusion, splenectomy is still a relevant option for treating adult primary ITP not responding to TPO-RAs and rituximab. Patients with lack of response or with relapse after splenectomy should be re-challenged with TPO-RAs.

摘要

虽然脾切除术仍然被认为是治疗免疫性血小板减少症 (ITP) 最有效的方法,但在过去十年中,其使用量显著下降,尤其是在血小板生成素受体激动剂 (TPO-RA) 获得批准之后。本研究的主要目的是确定脾切除术现在是否仍然有效,特别是对于对 TPO-RA 反应不佳的患者。我们的次要目的是评估在脾切除术后复发的患者中,脾切除术前使用的治疗方法的反应模式。这项多中心回顾性研究纳入了 2011 年至 2020 年在法国因 ITP 而行脾切除术的成年人。根据国际标准定义反应状态。我们纳入了 185 例患者,其中 100 例(54.1%)和 135 例(73.0%)患者在脾切除术前行 TPO-RA 和/或利妥昔单抗治疗。脾切除术后的中位随访时间为 39.2 个月[16.5-63.0]。总体而言,144 例(77.8%)患者有初始反应,23 例(12.4%)在随访期间复发,总持续反应率为 65.4%,与 TPO-RA 前相似。在脾切除术前行至少一种 TPO-RA 或利妥昔单抗治疗的患者中,92/151 例(60.9%)有持续反应。在既往对 TPO-RA 和利妥昔单抗均无反应的 13 例患者中,有 6 例对脾切除术有持续反应。在脾切除术后复发的患者中,13/21 例(61.2%)患者对脾切除术前失败的一种 TPO-RA 有反应。总之,脾切除术仍然是治疗对 TPO-RA 和利妥昔单抗无反应的成人原发性 ITP 的一种有效方法。脾切除术后无反应或复发的患者应再次接受 TPO-RA 治疗。

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