@article{N Vianelli_M Galli_A de Vivo_T Intermesoli_B Giannini_MG Mazzucconi_T Barbui_S Tura_M Baccaranion_Gruppo Italiano per lo Studio delle Malattie Ematologiche dell’Adulto_2005, place={Pavia, Italy}, title={Efficacy and safety of splenectomy in immune thrombocytopenic purpura: long-term results of 402 cases}, volume={90}, url={https://haematologica.org/article/view/3345}, DOI={10.3324/%x}, abstractNote={BACKGROUND AND OBJECTIVES: Immune thrombocytopenic purpura (ITP) is an acquired autoimmune disease characterized by platelet destruction. Glucocorticoids are the first-choice treatment, resulting in a complete (CR) or partial (PR) response in 70-80% of cases. In most cases, however, response is transient or glucocorticoid-dependent. For these and for selected patients with acute refractory ITP, splenectomy may produce a good response (CR+PR) in about 60-80% of cases. We report here the long-term outcome of a large cohort of ITP splenectomized patients. DESIGN AND METHODS: We retrospectively analyzed the data on 402 patients (137 males, 265 females) who underwent splenectomy for ITP between 1959 and 2002 in 22 different Hematology Centers. RESULTS: Seventy-nine of the 345 (23%) responsive patients relapsed, in most cases (80%) within 48 months from splenectomy. Sixty-eight out of these 79 patients (86%) were then treated with a good response in 46/68 (68%) cases. Fifty-four of the 57 patients refractory to splenectomy and were treated, after the surgery, with a good response in 27/54 (50%) cases. Infection and thrombosis did not significantly weigh upon the outcome of the patients. Only three patients died of hemorrhage during follow-up. By multivariate analysis, the number of therapies before (p<0.01) and higher peak post-splenectomy platelet count (p<0.00001) were predictive of a favorable response to splenectomy, whereas only higher post-splenectomy peak platelet count (p&lt;0.001) was predictive of relapse. INTERPRETATION AND CONCLUSIONS: This study shows that splenectomy is a safe procedure and effective in approximately two thirds of patients with chronic ITP. Further studies are required to establish whether surgery-sparing treatments of chronic ITP, such as high-dose dexamethasone, anti-D and anti-CD20 immunoglobulins, have similar or even superior efficacy, risk and cost ratios compared to splenectomy.}, number={1}, journal={Haematologica}, author={N Vianelli and M Galli and A de Vivo and T Intermesoli and B Giannini and MG Mazzucconi and T Barbui and S Tura and M Baccaranion and Gruppo Italiano per lo Studio delle Malattie Ematologiche dell’Adulto}, year={2005}, month={Jan.}, pages={72-77} }