Original Articles
Vol. 16 No. 1 (2024): Review Articles, Original Article, Scientific Letter, Case Reports Letter to the Editor
https://doi.org/10.4084/MJHID.2024.019

RITUXIMAB VERSUS SPLENECTOMY IN CHRONIC PRIMARY ITP: EXPERIENCE OF A SINGLE HEMATOLOGY CLINIC

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Received: November 19, 2023
Accepted: February 5, 2024
Published: February 29, 2024
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ITP, rituximab, splenectomy, complete response, second-line therapy

Authors

Rawanda Shamoon
rawand.shamoon@hmu.edu.krd
Department of Pathology, College of Medicine, Hawler Medical University, Erbil, Iraq. , .
Ahmed K. Yassin
Department of Internal Medicine, College of Medicine, Hawler Medical University, Erbil, Iraq. Department of Clinical Hematology, Nanakali Hospital of Blood Diseases and Cancer, Erbil, Iraq, Iraq.
Sara L. Alnuaimi
Department of Hematology, Nanakali Hospital of Blood Diseases and Cancer, Erbil, Iraq, Iraq.

Objective: Immune thrombocytopenia (ITP) is an acquired immune-mediated disease that lacks an underlying etiology. Steroids are the main first-line treatment of ITP, while the second-line treatment consists primarily of splenectomy and rituximab. This study aimed to assess and compare the response to rituximab and splenectomy.

Methods: This retrospective comparative study reviewed ITP patients treated at a single private hematology clinic from 2007 to 2019. Seventy-four ITP patients were recruited, 27 were on rituximab, and 47 had undergone splenectomy. The initial platelet counts and bleeding symptoms were recorded, and initial and long-term responses to treatment were evaluated based on the American Society of Hematology guidelines.

Results: The mean age of the patients was 42.1 years with a male-to-female ratio of 1:1.8. The initial mean platelet count was comparable between the rituximab and splenectomy groups (p = 0.749). The initial complete response (CR) differed significantly between the rituximab and splenectomy groups (44.4% versus 83%, p = 0.002). The five-year response rate was significantly higher in the splenectomy than in the rituximab group (74% versus 52%, log-rank 0.038). Splenectomy was the only significant predictive factor for long-term response (OR = 0.193, p = 0.006).

Conclusion: The overall response revealed that splenectomy appeared superior to rituximab as a second-line treatment of ITP. Splenectomy was the only positive prognostic indicator of sustained response.

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How to Cite



“RITUXIMAB VERSUS SPLENECTOMY IN CHRONIC PRIMARY ITP: EXPERIENCE OF A SINGLE HEMATOLOGY CLINIC” (2024) Mediterranean Journal of Hematology and Infectious Diseases, 16(1), p. e2024019. doi:10.4084/MJHID.2024.019.
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