Outcomes of Splenectomy in Relapsed/refractory Autoimmune Hemolytic Anemia

Objective To evaluate the outcomes of splenectomy in the treatment of relapsed/refractory autoimmune hemolytic anemia (AIHA).Methods Retrospective analysis was performed in 30 cases with relapsed/refractory AIHA who were treated with splenectomy in our hospital.The pre-and postoperative blood routine indexes and responses were followed up.Results Among the 30 relapsed/refractory AIHA patients,20 were pure AIHA (including 13 patients with warm antibody AIHA,2 with warm-cold double antibody AIHA and 5 with Coombs negative AIHA) and 10 were Evans syndrome.The short-term response was evaluated 10-14 days after operation,and the overall response rate (ORR) of shortterm response was 90％ [12 cases in complete response (CR),6 cases in partial response (PR)] in 20 therapeutic evaluable cases.Among 13 patients with long-term follow-up data,except 3 patients with Evans syndrome died (2 cases were refractory to splenectomy,1 case relapsed after surgery),the ORR of 10 patients with relapsed/refractory pure AIHA at 6 months and 12 months were 90％ (9/10) and 70％ (7/10),respectively,with a median follow-up of 14 (4-156) months.At the end of follow-up,3 cases had maintained CR for more than 3 years.Conclusion The short-term response of splenectomy as a secondline treatment for relapsed/refractory AIHA is satisfactory,and long-term outcome of splenectomy is up to 70 ％ at 1 year.Approximately one-third of patients could maintain sustained remission.