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Splenectomy is safe and effective in human immunodeficiency virus- related
immune thrombocytopenia [see comments]
E Oksenhendler, P Bierling, S Chevret, JF Delfraissy, Y Laurian, JP Clauvel and M Seligmann
Department of Immunopathology and Hematology, Hopital St Louis, Paris,
France.
Sixty-eight patients, followed in a prospective cohort study of 185 human
immunodeficiency virus (HIV)-infected patients with severe immune
thrombocytopenia (platelets < 50 x 10(9)/L), underwent splenectomy, 2 to
41 months (median: 10 months) after immune thrombocytopenic purpura (ITP)
was diagnosed. The mean platelet count increased from 18 x 10(9)/L to 223 x
10(9)/L with a persistent increase in 56 (82%). It also led to a
significant increase of the mean CD4 cell count from 475 x 10(6)/L to 725 x
10(6)/L within a mean delay of 10 months. In the whole cohort, with a mean
follow-up of 63 months (range, 6 to 126), the 5-year estimated rate for
progression to acquired immunodeficiency syndrome (AIDS) was 23% (95%
confidence interval [CI], 15% to 31%) and the AIDS-free survival was 69%
(95% CI, 61% to 77%). To investigate the potential impact of splenectomy, a
Cox's multiple regression model was used; as splenectomy was not randomly
assigned, it was incorporated as a time-dependent covariate. After
adjustment on the CD4 cell count, no statistically significant differences
were observed between the splenectomized and the nonsplenectomized
patients: AIDS progression rate (P = 0.23), survival (P = 0.64) and
AIDS-free survival (P = 0.72) were not influenced by splenectomy.
Splenectomy is both effective and safe in the treatment of severe,
refractory ITP associated with HIV infection.
Volume 82,
Issue 1,
pp. 29-32,
07/01/1993
Copyright © 1993 by The American Society of Hematology
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