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Durability of partial splenic artery embolization on platelet counts for cancer patients with hypersplenism-related thrombocytopenia

  • Interventional Radiology
  • Published:
Abdominal Radiology Aims and scope Submit manuscript

Abstract

Purpose

Partial splenic artery embolization (PSAE) has shown promise in increasing platelet counts in cancer patients with hypersplenism-related thrombocytopenia. The purpose of this study was to identify response predictors and to longitudinally evaluate PSAE efficacy and durability in a large cohort of cancer patients with hypersplenism-related thrombocytopenia.

Methods

A single-institution, IRB-approved, HIPAA-compliant retrospective review of all PSAEs for thrombocytopenia between 2012 and 2015 was performed. Patients were classified as complete responders (CR, no platelet value < 100 × 109/L following PSAE), partial responders (PR, initial increase in platelets but subsequent decrease in platelets < 100 × 109/L), and non-responders (NR, platelets never > 100 × 109/L following PSAE).

Results

Of the 98 patients included in the study, 58 had CR (59%), 28 had PR (29%), and 12 patients had NR (12%). The percent splenic tissue embolized was significantly greater in the CR group compared to the PR group (P = 0.001). The percent volume of splenic tissue embolized was linearly correlated with the magnitude of platelet increase without a minimum threshold. At least one line of chemotherapy was successfully restarted in 97% of patients, and 41% of patients did not experience recurrence of thrombocytopenia for the duration of their survival. The major complication rate was 8%, with readmission following initial hospitalization for persistent “post-embolization syndrome” symptoms the most common.

Conclusions

In cancer patients with hypersplenism-related thrombocytopenia, PSAE is a safe intervention that effects a durable elevation in platelet counts across a range of malignancies and following the re-initiation of chemotherapy.

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Acknowledgements

The authors gratefully acknowledge support from the MD Anderson Cancer Center institutional grant (NIH/NCI P30CA016672).

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No source of funding for this investigation.

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Authors and Affiliations

  1. University of Texas M.D. Anderson Cancer Center, Houston, USA

    Ashley Hill, Joshua Kuban, Bruno Odisio, Steven Y. Huang, Armeen Mahvash, Ethan Miller, Michael H. Kroll, Michael Overman, Alda L. Tam, Sanjay Gupta & Rahul A. Sheth

  2. Division of Interventional Neuroradiology, Department of Radiology, The Johns Hopkins Hospital, Baltimore, MD, USA

    Ahmed Elakkad

  3. Department of Radiology, Scripps Mercy Hospital, 4077 5th Ave, San Diego, CA, 92103, USA

    Sharjeel Sabir

  4. Department of Interventional Radiology, T. Boone Pickens Academic Tower (FCT14.5092), 1515 Holcombe Blvd., Unit 1471, Houston, TX, 77030, USA

    Rahul A. Sheth

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  1. Ashley Hill
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  2. Ahmed Elakkad
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All persons listed on this manuscript have met criteria for authorship and have participated sufficiently in the work, including participation in the concept, design, analysis, writing, or revision of the manuscript.

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Correspondence to Rahul A. Sheth.

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Hill, A., Elakkad, A., Kuban, J. et al. Durability of partial splenic artery embolization on platelet counts for cancer patients with hypersplenism-related thrombocytopenia. Abdom Radiol 45, 2886–2894 (2020). https://doi.org/10.1007/s00261-020-02523-5

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