Rituxan versus Splenectomy

Back in the hospital today and I was given two option for when I come off steroids in a few weeks. The doctor said I could take the rituxan anti body drug but he would recommend a splenectomy as I am so young and my ITP is less likely to return with this option.

What do yous think?

I dont know what to expect from either option as of yet

Seems to be a lot of people lately who are struggling with those same two options.

Here are some prior discussions:

www.pdsa.org/forum/5-newly-diagnosed-a-frequently-asked-questions/21214-how-longhow-many-meds-to-try-before-splenectomy.html

www.pdsa.org/forum/7-treatment-general/21284-treatment-crossroad.html

www.pdsa.org/forum/7-treatment-general/20434-nplate-had-a-stroke.html

Thanks for that, they were really helpful. I have read up a bit on these and most people say to try rituxan before the splenectomy but i think id like to get the splenectomy and have more of a chance of recovery. Compared to rituxan, my doctor feels it to be the better option for me

Personally, I would not do the Splenectomy. Once your spleen is removed there is no putting it back and you can still have further ITP issues. Plus with your Spleen removed you are more susceptible to serious or life threatning illness. There are risks with both treatments. I refused a Splenectomy. Have had two Rituxan treatments with better results the second time. To me a Splenectomy is old school, there are more treatment opitions now than in the past.
If you do not mind me asking, how old are you? My Daughter had a 19yr old friend that was recently diagnosed with ITP. She had a Splenectomy within a few months!! The most common reason for Splen removal is ruptured, enlarged and some blood disorders. I do not feel ITP is a blood disorder for a Splenectomy. The Spleen acts as a blood filter, so why remove it unless absolutely necessary. With ITP the Spleen is destroying Platelets as it sees the Platelets as a danger to the body. I feel my ITP was triggered due to a virus. Antibodies attach to the Platelets and are destroyed by the Spleen as the Spleen sees the affected Platelet as foreign. The Spleen helps the body fight infection.
Ultimatly it is your decession to make. Whatever you choose, I hope it gives you remission!!

Dean said; "To me a Splenectomy is old school, there are more treatment options now than in the past."

Old school indeed. Splenectomy as a treatment for ITP began in 1913! NINETY-NINE YEARS AGO!
When leeches were still a common medical treatment and Penicillin wasn't even discovered yet!
In short...back then there was nothing else available for ITP. Steroids weren't discovered until the mid-1940's, Prednisone in the early 1950's. Splenectomy was state-of-the-art in 1913 though!
These days, there are modern alternatives to try before a century-old organ removal process. Especially when that treatment process is 'iffy' (40%-60%) to begin with.

To put it in another light; How many of us currently drive a Ford Model T or a Stanley Steamer?

.

I have just gone 22. Yeah, the doctors more in favour of a splenectomy because he thinks it will have a better chance to get me back healthy. I have noticed a lot of people saying that you cant get your spleen put back in, that its a very final thing to do. But I dont want to try the rituxan and put myself through stress like while on steroids, always waiting to see if my count will rise. Ive read thats theres a better result from a splenectomy so atm I htink I am more in favour of that one

Lauralie, i questioned my hematologist when he recommended splenectomy. Originally he told me the success rate is about 70%, but, when i asked him about the percentage for PERMANENT recovery - that dropped to about 40% (his guess), meaning many people achieve short term remission, but eventually re-lapse. I was told i would HAVE TO have my spleen removed in 1999. I refused, and had almost a 13 year remission - until recently. Again splenectomy was recommended (thats when i questioned the statistics). 3 weeks ago, my platelets were down to 3. I am taking Danazol (which my hema. told me wont work) and a bunch of stuff from a Naturopath - (can list if interested).
When count was 3 I had 2 days of IVIG, and that got count to 169. last friday i was at 19, but, monday - up to 41 !
My hema. still does not think that danazol is effective, but, i still have my spleen, and i think im on the way back to remission (fingers crossed).
It gets frustrating - prednisone does not work for me, and i am a HUGE skeptic of the "medical industry" as they treat the symptom, not the problem. If you look at it a different way, is your spleen sick? Chances are it isnt, but removal MAY affect the symptom (low platelets). I personally have a childhood friend who did have a splenectomy, and it did nothing for him, now he has to have flu shots, and gets sick a lot more.
I would look at splenectomy as an absolute last resort, seems like a pretty big gamble, with pretty low odds.
Time, and patience are the key. Chances are, you will not die from ITP, and given time you will probably find something that will work.

This has been the only article with statistics that I could ever find on long-term success rates of splenectomy.


"Among 98 RefITP patients, no response to splenectomy was noted in 23 patients. The remaining patients had relapses after splenectomy at less than 1 month (19 patients), 1 to 3 months (28 patients), 3 to 6 months (6 patients), 6 to 12 months (7 patients), 1 to 5 years (10 patients), 5 to 10 years (4 patients), and more than 10 years (1 patient)."

bloodjournal.hematologylibrary.org/content/104/4/956.full

The long term results of a Splenectomy sure do not impress me!! Thanks for the results Sandi.