Long-term efficacy of partial splenic embolization for the treatment of steroid-resistant chronic immune thrombocytopenia
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....
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| Veröffentlicht in: | Annals of hematology 2018-04, Vol.97 (4), p.655-662 |
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| creator | 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 |
| description | 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
9
/L) was 51% (
n
= 46), and the overall response rate (CR plus response (R), > 30 × 10
9
/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
9
/L (
n
= 29) exhibited a significantly higher platelet count than the group with platelet count |
| doi_str_mv | 10.1007/s00277-018-3232-x |
| format | Article |
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9
/L) was 51% (
n
= 46), and the overall response rate (CR plus response (R), > 30 × 10
9
/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
9
/L (
n
= 29) exhibited a significantly higher platelet count than the group with platelet count < 300 × 10
9
/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.</description><identifier>ISSN: 0939-5555</identifier><identifier>EISSN: 1432-0584</identifier><identifier>DOI: 10.1007/s00277-018-3232-x</identifier><identifier>PMID: 29332223</identifier><language>eng</language><publisher>Berlin/Heidelberg: Springer Berlin Heidelberg</publisher><subject>Adolescent ; Adrenal Cortex Hormones - therapeutic use ; Adult ; Aged ; Aged, 80 and over ; Disease-Free Survival ; Drug Resistance ; Drug Resistance, Multiple ; Embolization ; Embolization, Therapeutic - adverse effects ; Female ; Follow-Up Studies ; Hematology ; Hospitals, University ; Humans ; Japan ; Male ; Medicine ; Medicine & Public Health ; Middle Aged ; Oncology ; Organ Size ; Original Article ; Purpura, Thrombocytopenic, Idiopathic - diagnostic imaging ; Purpura, Thrombocytopenic, Idiopathic - drug therapy ; Purpura, Thrombocytopenic, Idiopathic - pathology ; Purpura, Thrombocytopenic, Idiopathic - therapy ; Retrospective Studies ; Spleen - blood supply ; Spleen - diagnostic imaging ; Spleen - drug effects ; Spleen - pathology ; Steroids - therapeutic use ; Young Adult</subject><ispartof>Annals of hematology, 2018-04, Vol.97 (4), p.655-662</ispartof><rights>Springer-Verlag GmbH Germany, part of Springer Nature 2018</rights><rights>Annals of Hematology is a copyright of Springer, (2018). All Rights Reserved.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c438t-273d0c99ab621b77fee8cfaaba809e13a517a2ef7372bc48635212ec0a856bfa3</citedby><cites>FETCH-LOGICAL-c438t-273d0c99ab621b77fee8cfaaba809e13a517a2ef7372bc48635212ec0a856bfa3</cites><orcidid>0000-0003-1175-226X</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://link.springer.com/content/pdf/10.1007/s00277-018-3232-x$$EPDF$$P50$$Gspringer$$H</linktopdf><linktohtml>$$Uhttps://link.springer.com/10.1007/s00277-018-3232-x$$EHTML$$P50$$Gspringer$$H</linktohtml><link.rule.ids>314,776,780,27901,27902,41464,42533,51294</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/29332223$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Togasaki, Emi</creatorcontrib><creatorcontrib>Shimizu, Naomi</creatorcontrib><creatorcontrib>Nagao, Yuhei</creatorcontrib><creatorcontrib>Kawajiri-Manako, Chika</creatorcontrib><creatorcontrib>Shimizu, Ryoh</creatorcontrib><creatorcontrib>Oshima-Hasegawa, Nagisa</creatorcontrib><creatorcontrib>Muto, Tomoya</creatorcontrib><creatorcontrib>Tsukamoto, Shokichi</creatorcontrib><creatorcontrib>Mitsukawa, Shio</creatorcontrib><creatorcontrib>Takeda, Yusuke</creatorcontrib><creatorcontrib>Mimura, Naoya</creatorcontrib><creatorcontrib>Ohwada, Chikako</creatorcontrib><creatorcontrib>Takeuchi, Masahiro</creatorcontrib><creatorcontrib>Sakaida, Emiko</creatorcontrib><creatorcontrib>Iseki, Tohru</creatorcontrib><creatorcontrib>Yoshitomi, Hideyuki</creatorcontrib><creatorcontrib>Ohtsuka, Masayuki</creatorcontrib><creatorcontrib>Miyazaki, Masaru</creatorcontrib><creatorcontrib>Nakaseko, Chiaki</creatorcontrib><title>Long-term efficacy of partial splenic embolization for the treatment of steroid-resistant chronic immune thrombocytopenia</title><title>Annals of hematology</title><addtitle>Ann Hematol</addtitle><addtitle>Ann Hematol</addtitle><description>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
9
/L) was 51% (
n
= 46), and the overall response rate (CR plus response (R), > 30 × 10
9
/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
9
/L (
n
= 29) exhibited a significantly higher platelet count than the group with platelet count < 300 × 10
9
/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.</description><subject>Adolescent</subject><subject>Adrenal Cortex Hormones - therapeutic use</subject><subject>Adult</subject><subject>Aged</subject><subject>Aged, 80 and over</subject><subject>Disease-Free Survival</subject><subject>Drug Resistance</subject><subject>Drug Resistance, Multiple</subject><subject>Embolization</subject><subject>Embolization, Therapeutic - adverse effects</subject><subject>Female</subject><subject>Follow-Up Studies</subject><subject>Hematology</subject><subject>Hospitals, University</subject><subject>Humans</subject><subject>Japan</subject><subject>Male</subject><subject>Medicine</subject><subject>Medicine & Public Health</subject><subject>Middle Aged</subject><subject>Oncology</subject><subject>Organ Size</subject><subject>Original Article</subject><subject>Purpura, Thrombocytopenic, Idiopathic - diagnostic imaging</subject><subject>Purpura, Thrombocytopenic, Idiopathic - drug therapy</subject><subject>Purpura, Thrombocytopenic, Idiopathic - pathology</subject><subject>Purpura, Thrombocytopenic, Idiopathic - therapy</subject><subject>Retrospective Studies</subject><subject>Spleen - blood supply</subject><subject>Spleen - diagnostic imaging</subject><subject>Spleen - drug effects</subject><subject>Spleen - pathology</subject><subject>Steroids - therapeutic use</subject><subject>Young Adult</subject><issn>0939-5555</issn><issn>1432-0584</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2018</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>BENPR</sourceid><recordid>eNp1kU9PHCEYh4lpU1ftB-ilmaQXL7T8mVngaExrTTbxomfyDvuimJlhBCZx--nLZrUxJp0LAzy_B8KPkC-cfeeMqR-ZMaEUZVxTKaSgz0dkxdv6wzrdfiArZqShXf2OyUnOj4xxoVvxiRwLI6UQQq7IbhOne1owjQ16Hxy4XRN9M0MqAYYmzwNOwTU49nEIf6CEODU-pqY8YFMSQhlxKvtEro4YtjRhDrlAXXQPKe6zYRyXqdJ1Wi1uV-JcnXBGPnoYMn5-GU_J3a-ft5e_6ebm6vryYkNdK3WhQsktc8ZAvxa8V8ojaucBetDMIJfQcQUCvZJK9K7Va9kJLtAx0N269yBPyfnBO6f4tGAudgzZ4TDAhHHJlhttOlNfpK3ot3foY1zSVG9XKSOU6TqjK8UPlEsx54TezimMkHaWM7vvxR56sbUXu-_FPtfM1xfz0o-4_Zd4LaIC4gDkujXdY3pz9H-tfwEusZuZ</recordid><startdate>20180401</startdate><enddate>20180401</enddate><creator>Togasaki, Emi</creator><creator>Shimizu, Naomi</creator><creator>Nagao, Yuhei</creator><creator>Kawajiri-Manako, Chika</creator><creator>Shimizu, Ryoh</creator><creator>Oshima-Hasegawa, Nagisa</creator><creator>Muto, Tomoya</creator><creator>Tsukamoto, Shokichi</creator><creator>Mitsukawa, Shio</creator><creator>Takeda, Yusuke</creator><creator>Mimura, Naoya</creator><creator>Ohwada, Chikako</creator><creator>Takeuchi, Masahiro</creator><creator>Sakaida, Emiko</creator><creator>Iseki, Tohru</creator><creator>Yoshitomi, Hideyuki</creator><creator>Ohtsuka, Masayuki</creator><creator>Miyazaki, Masaru</creator><creator>Nakaseko, Chiaki</creator><general>Springer Berlin Heidelberg</general><general>Springer Nature B.V</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7RV</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8AO</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>K9.</scope><scope>KB0</scope><scope>M0S</scope><scope>M1P</scope><scope>NAPCQ</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0003-1175-226X</orcidid></search><sort><creationdate>20180401</creationdate><title>Long-term efficacy of partial splenic embolization for the treatment of steroid-resistant chronic immune thrombocytopenia</title><author>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</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c438t-273d0c99ab621b77fee8cfaaba809e13a517a2ef7372bc48635212ec0a856bfa3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2018</creationdate><topic>Adolescent</topic><topic>Adrenal Cortex Hormones - therapeutic use</topic><topic>Adult</topic><topic>Aged</topic><topic>Aged, 80 and over</topic><topic>Disease-Free Survival</topic><topic>Drug Resistance</topic><topic>Drug Resistance, Multiple</topic><topic>Embolization</topic><topic>Embolization, Therapeutic - adverse effects</topic><topic>Female</topic><topic>Follow-Up Studies</topic><topic>Hematology</topic><topic>Hospitals, University</topic><topic>Humans</topic><topic>Japan</topic><topic>Male</topic><topic>Medicine</topic><topic>Medicine & Public Health</topic><topic>Middle Aged</topic><topic>Oncology</topic><topic>Organ Size</topic><topic>Original Article</topic><topic>Purpura, Thrombocytopenic, Idiopathic - diagnostic imaging</topic><topic>Purpura, Thrombocytopenic, Idiopathic - drug therapy</topic><topic>Purpura, Thrombocytopenic, Idiopathic - pathology</topic><topic>Purpura, Thrombocytopenic, Idiopathic - therapy</topic><topic>Retrospective Studies</topic><topic>Spleen - blood supply</topic><topic>Spleen - diagnostic imaging</topic><topic>Spleen - drug effects</topic><topic>Spleen - pathology</topic><topic>Steroids - therapeutic use</topic><topic>Young Adult</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Togasaki, Emi</creatorcontrib><creatorcontrib>Shimizu, Naomi</creatorcontrib><creatorcontrib>Nagao, Yuhei</creatorcontrib><creatorcontrib>Kawajiri-Manako, Chika</creatorcontrib><creatorcontrib>Shimizu, Ryoh</creatorcontrib><creatorcontrib>Oshima-Hasegawa, Nagisa</creatorcontrib><creatorcontrib>Muto, Tomoya</creatorcontrib><creatorcontrib>Tsukamoto, Shokichi</creatorcontrib><creatorcontrib>Mitsukawa, Shio</creatorcontrib><creatorcontrib>Takeda, Yusuke</creatorcontrib><creatorcontrib>Mimura, Naoya</creatorcontrib><creatorcontrib>Ohwada, Chikako</creatorcontrib><creatorcontrib>Takeuchi, Masahiro</creatorcontrib><creatorcontrib>Sakaida, Emiko</creatorcontrib><creatorcontrib>Iseki, Tohru</creatorcontrib><creatorcontrib>Yoshitomi, Hideyuki</creatorcontrib><creatorcontrib>Ohtsuka, Masayuki</creatorcontrib><creatorcontrib>Miyazaki, Masaru</creatorcontrib><creatorcontrib>Nakaseko, Chiaki</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Nursing & Allied Health Database</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>ProQuest Pharma Collection</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Nursing & Allied Health Database (Alumni Edition)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Medical Database</collection><collection>Nursing & Allied Health Premium</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>MEDLINE - Academic</collection><jtitle>Annals of hematology</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Togasaki, Emi</au><au>Shimizu, Naomi</au><au>Nagao, Yuhei</au><au>Kawajiri-Manako, Chika</au><au>Shimizu, Ryoh</au><au>Oshima-Hasegawa, Nagisa</au><au>Muto, Tomoya</au><au>Tsukamoto, Shokichi</au><au>Mitsukawa, Shio</au><au>Takeda, Yusuke</au><au>Mimura, Naoya</au><au>Ohwada, Chikako</au><au>Takeuchi, Masahiro</au><au>Sakaida, Emiko</au><au>Iseki, Tohru</au><au>Yoshitomi, Hideyuki</au><au>Ohtsuka, Masayuki</au><au>Miyazaki, Masaru</au><au>Nakaseko, Chiaki</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Long-term efficacy of partial splenic embolization for the treatment of steroid-resistant chronic immune thrombocytopenia</atitle><jtitle>Annals of hematology</jtitle><stitle>Ann Hematol</stitle><addtitle>Ann Hematol</addtitle><date>2018-04-01</date><risdate>2018</risdate><volume>97</volume><issue>4</issue><spage>655</spage><epage>662</epage><pages>655-662</pages><issn>0939-5555</issn><eissn>1432-0584</eissn><abstract>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
9
/L) was 51% (
n
= 46), and the overall response rate (CR plus response (R), > 30 × 10
9
/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
9
/L (
n
= 29) exhibited a significantly higher platelet count than the group with platelet count < 300 × 10
9
/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.</abstract><cop>Berlin/Heidelberg</cop><pub>Springer Berlin Heidelberg</pub><pmid>29332223</pmid><doi>10.1007/s00277-018-3232-x</doi><tpages>8</tpages><orcidid>https://orcid.org/0000-0003-1175-226X</orcidid></addata></record> |
| fulltext | fulltext |
| identifier | ISSN: 0939-5555 |
| ispartof | Annals of hematology, 2018-04, Vol.97 (4), p.655-662 |
| issn | 0939-5555 1432-0584 |
| language | eng |
| recordid | cdi_proquest_miscellaneous_1989592934 |
| source | MEDLINE; Springer Nature - Complete Springer Journals |
| subjects | Adolescent Adrenal Cortex Hormones - therapeutic use Adult Aged Aged, 80 and over Disease-Free Survival Drug Resistance Drug Resistance, Multiple Embolization Embolization, Therapeutic - adverse effects Female Follow-Up Studies Hematology Hospitals, University Humans Japan Male Medicine Medicine & Public Health Middle Aged Oncology Organ Size Original Article Purpura, Thrombocytopenic, Idiopathic - diagnostic imaging Purpura, Thrombocytopenic, Idiopathic - drug therapy Purpura, Thrombocytopenic, Idiopathic - pathology Purpura, Thrombocytopenic, Idiopathic - therapy Retrospective Studies Spleen - blood supply Spleen - diagnostic imaging Spleen - drug effects Spleen - pathology Steroids - therapeutic use Young Adult |
| title | Long-term efficacy of partial splenic embolization for the treatment of steroid-resistant chronic immune thrombocytopenia |
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