Is there any Role for Splenectomy in Adulthood Onset Chronic Immun e Thrombocytopenia in the Era of TPO Receptors Agonists? A Critic al Overview.

Milunovic Vibor, Inga Mandac Rogulj, S. Ostojić
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引用次数: 4

Abstract

BACKGROUND Immune thrombocytopenia (ITP) in adulthood is characterized by chronic relapsing course. Despite the efficacious first line treatment (corticosteroid, intravenous immunoglobulin), majority of patients will enter the chronic phase warranting another treatment approach. Until recently, splenectomy performed in ITP chronic phase represented the standard of care with longterm remissions in more than 70% of patients, but it has never been tested in clinical trials. However, with the advances of our understanding of ITP pathophysiology and the shifting focus on megakaryocyte impairment, novel drugs were introduced in the treatment paradigm, mainly trombopoietin receptor agonists (TPO-RAs); romiplostim and eltrombopag. METHODS These TPO-RAs were tested in randomized controlled trials resulting in adequate platelet response with few side effects and less need for additional therapy leading to approval of corresponding regulatory agencies and wide acceptance by hematological community, but however TPO-RAs must be taken continuously to maintain the response. With their onset, the rate of splenectomy in chronic ITP has diminished in modern era. CONCLUSION The main aim behind conducting this review is to evaluate the pros and cons of splenectomy compared to TPO-RAs treatment in order to provide the critical overview which may help the practicing clinician in managing often challenging cases of chronic ITP.
在TPO受体激动剂时代,脾切除术在成年期慢性免疫性血小板减少症中是否有作用?一个批判性的概述。
背景:成年期免疫性血小板减少症(ITP)的特点是慢性复发。尽管有有效的一线治疗(皮质类固醇、静脉注射免疫球蛋白),但大多数患者将进入慢性期,需要另一种治疗方法。直到最近,在超过70%的患者中,在ITP慢性期进行脾切除术是长期缓解的标准治疗方法,但从未在临床试验中进行过测试。然而,随着我们对ITP病理生理的理解的进步和对巨核细胞损伤的关注的转移,新的药物被引入治疗模式,主要是血小板生成素受体激动剂(TPO-RAs);Romiplostim和电子宝。方法在随机对照试验中对这些TPO-RAs进行了测试,结果表明这些TPO-RAs具有足够的血小板反应,副作用少,无需额外治疗,获得了相应监管机构的批准,并被血液学界广泛接受,但TPO-RAs必须持续服用以维持反应。随着他们的发病,慢性ITP的脾切除术率在现代已经减少。结论:本综述的主要目的是评估脾切除术与TPO-RAs治疗的利弊,以提供关键的概述,这可能有助于临床医生管理慢性ITP的挑战性病例。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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