Success Rate of Aged ITP Patients

I am 72 closing in on 73. I have heard and read about the high (66 to 70-80%) rate of success of having a splenectomy but I have not seen much material on how these rates are affected by one's age.

I was diagnosed three years ago when my level dropped to 27 showing large bruising signs. 18 months previously, I was at 350, a consistent number over the previous 10 years. Then I had a knee operation. 11 months later I was at 194 but no one took notice. In fact, my substitute GP prescribed baby aspirin daily "because of my age" at that time (69). When my bruises appeared 7 months later, the first thing the doctors ordered were to take me off the aspirin!

During 10 weeks of prednisone (started at 75mgms daily then weaned down to zero), my platelet levels rose to 300 but after stopping prednisone, over a ten week period they kept dropping to to maintain levels ranging from mid-forties to 120s for the next two years. In April of this year, my blood test read 19 so I was put back on prednisone for six weeks during which my levels rose to low 200s. I am now off prednisone for a week and will be taking another "reading" later this week (June 15th).

My hematologist is asking me to decide to have a splenectomy or continue on the Prednisone cycle, when needed. I would like to know the outcomes (pros and cons) of a splenectomy for those in my age bracket before making a decision. Any experiences out there, please?

Chico:

I don't know that the splenectomy success rate gets lower with age, but I have read evidence that it is less successful for those over 40.

Here are some articles:

onlinelibrary.wiley.com/doi/10.1111/ejh.12146/abstract

Of 105 patients with RefITP and long-term follow-up, 75 (71.4%) patients attained stable CR or PR. In 51 (48.6%) patients, remission persisted after therapy was discontinued, whereas 24 (22.9%) patients required continued treatment, usually with lowdose corticosteroids or danazol. There was no statistical relationship between the likelihood of attaining stable CR or PR after splenectomy failure and any of the following: patient age (younger than 40 vs older than 40, P = .52; younger than 50 vs older than 50, P = 1.0; younger than 60 vs older than 60, P = .170), time from the diagnosis of ITP to splenectomy (less than 3 months vs more than 3 months, P = .19; less than 6 months vs more than 6 months, P = .18; less than 12 months vs more than 12 months, P = .48), or time from splenectomy to relapse (no response vs temporary response, P = 1.00; less than 1 month vs more than 1 month, P = .25; less than 3 months vs more than 3 months, P = .13; less than 6 months vs more than 6 months, P = .29).

www.bloodjournal.org/content/104/4/956?sso-checked=true

I'm surprised that your doctor only gave you two options. There are others that can be considered and I would suggest getting a second opinion. A Hemo who is not familiar with or does not present other options is one that I would be leery of. Splenectomies are also becoming a thing of the past and few doctors recommend them these days.

PS - your count of 194 after the knee operation is a perfectly good count, and I don't know of any doctor that would think a thing of it. Platelet counts fluctuate all the time and that one was well above normal. An aspirin regimen seems like a perfectly logical thing to recommend. Aspirin can usually be taken if counts are above 50k. I take aspirin recommended by my doctor for several health issues.

I'm 65, not so much younger than you. Every doctor I visited last year... Two hematologists, an internist, a cardiologist, and a foot doctor ... All were insisting that splenectomy would be my new best friend. There's no way I would opt for it after what I dug up on the risks and the success rate. The risks of the surgery itself from anesthesia and other internal organ damage, clotting after the surgery, increased risk of heart disease and dementia, etc... are much greater than those of brain or other hemorrhagic bleeding from ITP.

It appears splenectomy works best in those around 35 or so. The success rate for them is about 66%, nowhere near 80% for any age group. The rate declines as the years go by. I, too, couldn't find a whole lot about older patients; but I did find one reference saying the rate is around 40% or less.

You have to remember, too, that the "success" rate includes those for whom the procedure is successful for only about a year or two. After that, you're back to square one with treatments options.

I started NPlate in January. Am still on a smallish dose of Prednisone ( 5 - 20 mgs, depending on count) and am trying to wean off with little luck so far.

Have an indium scan before even considering a splenectomy..

Why do you suggest this? Have you had a bad experience?

The Indium can tell you where the site of platelet destruction is...the spleen or the liver. It cannot determine splenectomy success, but it can determine if it would be a failure if most of the destruction is in the liver. That could save someone from having an unnecessary, unsuccessful splenectomy.

I have taken prednisone and my playlets dropped. Has anyone else had that to happen to them?

Yes, many have had that happen. It happens more often than not. There are other treatments to try.

I developed itp at 65. An indium scan showed as much destruction in my liver as spleen so no splenectomy suggested . Eltrombopag worked for 30 months then tailed off. Now about to try Romiplostin- Nplate.