Partial splenic embolization in chemotherapy-induced thrombocytopenia: A retrospective analysis with long term follow-up.

Abstract

e21654 Background: Chemotherapy-induced thrombocytopenia (CIT) may result in a chemotherapy (CT) dose delay or reduction, thus affecting dose density and intensity. Historically, partial splenic embolization (PSE) has been performed to improve hematologic parameters related to hypersplenism. In this study we reviewed our institutional experience with PSE for gastrointestinal cancer (GI) experiencing CIT. Methods: A retrospective analysis of GI cancer patients with splenomegaly undergoing PSE was performed. Mean PLT (platelet) count was collected at the following time points: before CT start; at nadir pre-PSE; 1 week before PSE (pre-PSE); 4 weeks after PSE (post-PSE); and at the nadir after CT reintroduction post PSE. Time to CT restart after PSE, time to recurrent CIT, periprocedural lab values and adverse events were recorded. Wilcoxon test was adopted to exploratively compare PLT count before and after PSE. Results: 11 patients underwent PSE, 5 with colorectal, 3 with pancreatic and 3 with biliary cancer, 73% had metastatic disease. Baseline PLT count before initiation of CT was 146 x109/L (range, 81-255 x 109/L). PLT count at nadir pre-PSE was 60 x109/L (range, 44-82 x 109/L), and pre-PSE PLT count was 78 x109/L (range, 62-99 x 109/L). Post-PSE PLT count improved significantly ( 132 x 109/L; range, 67-172 x109/L) compared with nadir pre-PSE (p = 0.003). The mean hospital stay was 1 day. Post-procedure abdominal pain occurred in 3 patients. All patients resumed CT and mean time to CT re-start after PSE was 43 days (range, 4-193 d). All patients exhibited recurrent thrombocytopenia. PLT count at nadir after PSE was 54 x 109/L (range, 28-78 x 109/L) and occurred at a mean of 169 days after PSE (range, 37-664 d) No differences were observed when comparing CIT at nadir pre and post PSE (p = 0.447). All patients experienced CT dose delay and 82% of them experienced dose reduction after PSE. Conclusions: Our findings underline that PSE is safe and effective to achieve short-term improvement of CIT and resumption of CT in GI patients. However, PSE does not sustain long-term adequate PLT count. Further studies may help guide patient selection by identifying characteristics that allow a sustained improvement in CIT.