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Sequence of Splenectomy and Rituximab for the Treatment of Steroid-Refractory Immune Thrombocytopenia: Does It Matter?
Mayo Clinic Proceedings ( IF 8.9 ) Pub Date : 2019-11-01 , DOI: 10.1016/j.mayocp.2019.05.024
William A Hammond 1 , Prakash Vishnu 2 , Elisa M Rodriguez 3 , Zhuo Li 4 , Bhagirathbhai Dholaria 5 , Amanda J Shreders 1 , Candido E Rivera 2
Affiliation  

OBJECTIVE To evaluate the impact of the sequence of treatment with rituximab and/or splenectomy on time to relapse for patients with steroid-refractory immune thrombocytopenia (ITP). PATIENTS AND METHODS Patients 18 years or older with steroid-refractory immune thrombocytopenia who underwent treatment with splenectomy or rituximab from January 1, 2002, through December 31, 2015, at Mayo Clinic. Evaluation included freedom from relapse (FFR) and response rates after treatment with rituximab or splenectomy as single or sequential interventions. RESULTS A total of 218 eligible patients with ITP who were treated according to standard of care were included in this analysis. Patients failing steroids treated with splenectomy had a higher 5-year FFR than did those treated with rituximab (67.4% vs 19.2%; P<.001, propensity-score matched). Patients who failed splenectomy and were then treated with rituximab had a 2-year FFR similar to that of patients who failed rituximab and were then treated with splenectomy (73.4% vs 59.9%; P=.52). Patients treated with rituximab after splenectomy had a longer 2-year FFR than did patients treated with rituximab as a second-line treatment (73.4% vs 29.0%; P<.001). CONCLUSION For patients with ITP that relapse after treatment with steroids, splenectomy provides longer FFR than rituximab as a second-line therapy. Among patients who fail second-line treatment with splenectomy or rituximab, those who end up receiving sequential splenectomy-rituximab or rituximab-splenectomy therapy seem to derive similar benefit in the long term. Patients who received rituximab after splenectomy seem to derive superior benefit than do those who are treated with rituximab with an intact spleen.

中文翻译:

脾切除和利妥昔单抗治疗类固醇难治性免疫性血小板减少症的顺序:重要吗?

目的评估类固醇难治性免疫血小板减少症(ITP)患者接受利妥昔单抗和/或脾切除术的治疗顺序对复发时间的影响。患者和方法自2002年1月1日至2015年12月31日在Mayo诊所接受脾切除术或利妥昔单抗治疗的18岁或以上的类固醇难治性免疫血小板减少症患者。评估包括使用利妥昔单抗或脾切除术作为单一或顺序干预措施后的无复发(FFR)和缓解率。结果本分析共纳入了218名符合ITP标准的符合条件的ITP患者。脾切除失败的类固醇患者的5年FFR高于利妥昔单抗治疗的患者(67.4%比19.2%; P <.001,倾向评分匹配)。脾切除术失败并随后接受利妥昔单抗治疗的患者的2年FFR与利妥昔单抗治疗失败并随后接受脾切除术的患者相似(73.4%vs 59.9%; P = .52)。脾切除术后接受利妥昔单抗治疗的患者的二年FFR要长于接受利妥昔单抗作为二线治疗的患者(73.4%vs 29.0%; P <.001)。结论对于类固醇治疗后复发的ITP患者,作为第二线治疗,脾切除术比利妥昔单抗提供更长的FFR。在长期接受二线脾切除术或利妥昔单抗治疗的患者中,那些最终接受序贯脾切除术-利妥昔单抗或利妥昔单抗-脾切除术的患者似乎从长期获益。
更新日期:2019-11-01
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