Long-term efficacy of partial splenic embolization for the treatment of steroid-resistant chronic immune thrombocytopenia

• DOI: 10.1007/s00277-018-3232-x
• Publication Date: 2018-01-13T02:12:15Z
• Authors: Emi Togasaki; Naomi Shimizu; Yuhei Nagao; Chika Kawajiri-Ma...; Ryoh Shimizu; Nagisa Oshima-Has...; Tomoya Muto; Shokichi Tsukamoto; Shio Mitsukawa; Yusuke Takeda; Naoya Mimura; Chikako Ohwada; Masahiro Takeuchi; Emiko Sakaida; Tohru Iseki; Hideyuki Yoshitomi; Masayuki Ohtsuka; Masaru Miyazaki; Chiaki Nakaseko
• Keywords: Adult; Aged, 80 and over; Male; Purpura, Thrombocytopenic, Idiopathic; Adolescent; Drug Resistance; Organ Size; Middle Aged; Embolization, Therapeutic; Disease-Free Survival; Drug Resistance, Multiple; 3. Good health; Hospitals, University; 03 medical and health sciences; 0302 clinical medicine; Japan; Adrenal Cortex Hormones; Humans; Female; Spleen; Aged; Follow-Up Studies; Retrospective Studies

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 × 109/L) was 51% (n = 46), and the overall response rate (CR plus response (R), > 30 × 109/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 × 109/L (n = 29) exhibited a significantly higher platelet count than the group with platelet count < 300 × 109/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.