Have splenectomy rate and main outcomes of XXXX changed after the introduction of new treatments? A monocentric study in the outpatient setting during 35 years.

@entity1 @entity20096 @entity548 @entity229 @entity3039 @entity288
UNASSIGNED: In the last years, rituximab (RTX) and agonists of the @entity20096 ( @entity20096 ) eltrombopag and romiplostim have provided new treatment options in persistent and chronic @entity3039 ( @entity3039 ). Here, we analyzed the changes in therapeutic choices over time and their impact on clinical outcomes in a cohort of 557 @entity3039 outpatients followed at the "L. and A. Ser  gnoli" Institute of Hematology, Bologna, Italy, from 1980 to 2015. Overall 397 @entity1 (71%) required front-line corticosteroids, mainly @entity229 . Over the decades, splenectomy was delayed from second to third-line, but was steadily used in around 15-25% of @entity1 refractory or relapsing after first-line treatment. Consensually, RTX and @entity20096 agonists emerged as second and third-line therapy of choice, respectively. Splenectomy was associated with the best response rates and the lower incidences of relapse, while the relapse rate after RTX was comparable to that observed with @entity288 and other immunosuppressive agents. The introduction of @entity20096 agonists gave an alternative to the administration of immunosuppressive drugs and probably contributed to moderate the incidence of infectious complications that remained stable over the decades, despite an increasing use of RTX from the 2000s onwards. Overall responses were similar over time, with over 97% achieving a response in all time-periods. However, the cumulative risk of @entity548 significantly decreased (14.3% [1980-89] versus 7% [1990-99] versus 5.6% [2000-09] versus 0.2% [2010-15]) (p<0.001), mainly thanks to the optimization of front-line corticosteroids therapy and to the wider availability of second and third-line therapies. This article is protected by copyright. All rights reserved.
