Age as the major predictive factor of long‐term response to splenectomy in immune thrombocytopenic purpura

Abstract

Sixty‐one consecutive patients undergoing splenectomy for chronic immune thrombocytopenia were retrospectively evaluated. Platelet response was considered as complete (CR) when platelet count rose to > 100 × 10⁹/l, partial (PR) when 30–100 × 10⁹/l or absent (NR) if otherwise. Follow‐up (mean time 7·6 years) was possible in 54 patients. Forty‐eight patients (88%) had an immediate response to splenectomy (39 CR, 9 PR) whereas six (12%) were NR. Thirty‐six responders (67%) had sustained remission (31 CR; 5 PR) without further treatment; thrombocytopenia recurred in 12 patients (33%). The probability curve of continued remission showed a constant relapse‐rate during the first 36 months; a further step of relapse was observed beginning 70 months after surgery. The only positive predictive factor for the long‐term response to splenectomy was age < 40 (P < 0·005). Neither duration of thrombocytopenia nor previous response to medical treatment (steroids and/or intravenous immunoglobulins) were related to splenectomy response.