International Journal of Hematology

DOI: 10.1007/s12185-017-2325-y Pages: 69-74

Splenectomy vs. rituximab as a second-line therapy in immune thrombocytopenic purpura: a single center experience

1. National Guard Health Affairs, Division of Adult Hematology and SCT, King Abdulaziz Medical City

2. King Abdullah International Medical Research Center

3. King Saud Bin Abdulaziz University for Health Sciences

Correspondence to:
Ahmed S. Al Askar
Email: askaras@ngha.med.sa

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Abstract

Immune thrombocytopenic purpura (ITP) is a common hematological disease treated primarily by corticosteroids. The aim of the present study was to compare response rate between patients, underwent splenectomy vs. rituximab as second-line therapy. Adult patients diagnosed with ITP who did not respond to corticosteroids or relapsed during the period 1990–2014 were included in a quasi-experimental study. Categorical variables were compared using Fisher exact test. Response to treatment was compared using logistic regression. Data were analyzed using SAS V9.2. One-hundred and forty-three patients with ITP were identified through medical records. Of 62 patients treated, 30 (48.38%) required second-line therapy. 19 (63%) patients received rituximab, and 11 (37%) underwent splenectomy. Platelets at diagnosis were not different between study groups (p = 0.062). Splenectomy group patients were younger (p = 0.011). Response to second-line therapy showed no significant difference between two groups (OR 2.03, 95% CI (0.21–22.09), p = 0.549). Results did not show a statistically significant difference in platelet counts over time between treatment groups (p = 0.101). When used exclusively as a second-line therapy for steroid-refractory ITP, the response rate was not statistically different between rituximab and splenectomy. However, further large studies are needed to assess the response rates for these treatment modalities as a second-line therapy.

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