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Blood, 15 August 2004, Vol. 104, No. 4, pp. 956-960.
Prepublished online as a Blood First Edition Paper on April 20, 2004; DOI 10.1182/blood-2003-11-3908.
 Previous Article | Next Article 
Submitted November 14, 2003
Accepted April 8, 2004
The Long-term Outcome of Adult Chronic ITP Patients Who Fail Splenectomy
Robert McMillan* and Carol Durette
The Scripps Research Institute and the General Clinical Research Center of the Green Hospital, La Jolla, CA, USA
* Corresponding author; email: mcmillan{at}scripps.edu.
Adult chronic ITP is an autoimmune disorder manifested by thrombocytopenia due to the effects of antiplatelet autoantibodies and T lymphocyte-mediated platelet cytotoxicity. Mulitple studies show that treatment with corticosteroids and/or splenectomy increases the platelet count to safe levels in 60-70% of patients. However, there is little information on the outcome of ITP patients refractory to splenectomy. We studied 114 patients with ITP who failed splenectomy and required additional therapy; long-term followup was available on 105 patients (92%). Remissions. 75 patients (71.4%) attained a stable partial (platelet count >30,000/mm3) or complete (normal platelet count) remission; 51 patients maintained their remission after stopping therapy while 24 patients required continued treatment. The median time to remission following splenectomy failure was 46 months (range: 1-437 months). The median remission durations were: Off therapy- 60 months (range 10-212) and On therapy- 48 months (range 2-167). Treatment Failure. 30 patients (29.6%) remained unresponsive to treatment. Mortality. 32 patients died, 17 (15.7%) due to ITP (bleeding-11 patients, therapy complications- 6 patients) and 15 patients (13.9%) of unrelated causes. We conclude that most refractory ITP patients attain a stable remission although, on average, this occurs slowly. However, a subpopulation with severe, resistant disease has significant morbidity and mortality.
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