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Rituximab After Splenectomy Yields Superior Benefit in Steroid-Refractory ITP
Patients with steroid-refractory immune thrombocytopenia (ITP) who received rituximab after splenectomy derived superior benefit compared with those given rituximab before splenectomy, according to William A. Hammond, MD, FACP, Division of Hematology and Medical Oncology, Mayo Clinic, Jacksonville, Florida, and colleagues (Mayo Clin Proc. 2019;94[11]:2199-2208).
To assess the effect treatment sequence has on time to relapse, Dr Hammond et al evaluated freedom from relapse (FFR) and response rates after rituximab or splenectomy as single or sequential interventions in 218 patients with steroid-refractory ITP.
All patients in the study underwent treatment with splenectomy or rituximab from January 1, 2002, through December 31, 2015, at Mayo Clinic.
Patients who did not respond to steroids and underwent splenectomy had a higher 5-year FFR than those given rituximab (67.4% vs 19.2%, respectively; P <.001, propensity-score matched). In addition, those who did not respond to a splenectomy and were then given rituximab had a 2-year FFR similar to that of patients who did not respond to rituximab before undergoing splenectomy (73.4% vs 59.9%, respectively; P = .52).
Of note, patients had a longer 2-year FFR when treated with rituximab after splenectomy compared with those given rituximab as a second-line treatment (73.4% vs 29.0%, respectively; P <.001).
“For patients with ITP that relapse after treatment with steroids, splenectomy provides longer FFR than rituximab as a second-line therapy,” Dr Hammond and colleagues reported.
“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,” they concluded.—Hina Porcelli
