Proximal Splenic Artery Embolization in Chemotherapy-Induced Thrombocytopenia

A Retrospective Analysis of 13 Patients

Shivank Bhatia, Shree Venkat, Ana Echenique, Caio Rocha-Lima, Mehul Doshi, Jason Salsamendi, Katuska Barbery, Govindarajan Narayanan

Research output: Contribution to journalArticle

4 Citations (Scopus)

Abstract

Purpose: To determine if proximal splenic artery embolization (PSAE) provides a safe and effective alternative to alleviate chemotherapy-induced thrombocytopenia (CIT), allowing patients with cancer to resume chemotherapy regimens. Materials and Methods: Thirteen patients (9 men, 4 women; mean age, 63 y) with underlying malignancy (pancreatic adenocarcinoma, n = 6; cholangiocarcinoma, n = 5; other, n = 2) complicated by CIT underwent PSAE. Mean platelet counts were calculated before the initiation of chemotherapy, at the nadir that resulted in discontinuation of chemotherapy before the PSAE procedure, at peak values after the procedure, and at a mean follow-up of 9.2 months. The time to reinitiation of chemotherapy after PSAE was calculated. Results: Baseline platelet count before initiation of chemotherapy was 162 × 10<sup>9</sup>/L (range, 90-272 × 10<sup>9</sup>/L). The platelet count nadir resulting in cessation of chemotherapy was 45 × 10<sup>9</sup>/L (range, 23-67 × 10<sup>9</sup>/L), and the pre-PSAE platelet count was 88 × 10<sup>9</sup>/L (range, 49-131 × 10<sup>9</sup>/L). The post-PSAE peak platelet count improved significantly (to 209 × 10<sup>9</sup>/L; range, 83-363 × 10<sup>9</sup>/L) compared with the nadir counts and the pre-PSAE counts (P < .01) at a mean short-term follow-up of 35 days (range, 7-91 d). The counts at follow-up to 9.2 months (range, 3-15 mo) were 152 × 10<sup>9</sup>/L (range, 91-241 × 10<sup>9</sup>/L). All patients became eligible to resume chemotherapy. The time to initiation of chemotherapy after PSAE averaged 22 days (range, 4-58 d) in 12 patients; one patient declined chemotherapy. Conclusions: Proximal splenic artery embolization appears to be safe and effective in alleviating CIT, allowing resumption of systemic chemotherapy. Further studies may help guide patient selection by identifying characteristics that allow a sustained improvement in thrombocytopenia.

Original languageEnglish (US)
JournalJournal of Vascular and Interventional Radiology
DOIs
StateAccepted/In press - Mar 31 2014

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Splenic Artery
Thrombocytopenia
Drug Therapy
Platelet Count
Cholangiocarcinoma
Patient Selection

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging
  • Cardiology and Cardiovascular Medicine

Cite this

Proximal Splenic Artery Embolization in Chemotherapy-Induced Thrombocytopenia : A Retrospective Analysis of 13 Patients. / Bhatia, Shivank; Venkat, Shree; Echenique, Ana; Rocha-Lima, Caio; Doshi, Mehul; Salsamendi, Jason; Barbery, Katuska; Narayanan, Govindarajan.

In: Journal of Vascular and Interventional Radiology, 31.03.2014.

Research output: Contribution to journalArticle

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abstract = "Purpose: To determine if proximal splenic artery embolization (PSAE) provides a safe and effective alternative to alleviate chemotherapy-induced thrombocytopenia (CIT), allowing patients with cancer to resume chemotherapy regimens. Materials and Methods: Thirteen patients (9 men, 4 women; mean age, 63 y) with underlying malignancy (pancreatic adenocarcinoma, n = 6; cholangiocarcinoma, n = 5; other, n = 2) complicated by CIT underwent PSAE. Mean platelet counts were calculated before the initiation of chemotherapy, at the nadir that resulted in discontinuation of chemotherapy before the PSAE procedure, at peak values after the procedure, and at a mean follow-up of 9.2 months. The time to reinitiation of chemotherapy after PSAE was calculated. Results: Baseline platelet count before initiation of chemotherapy was 162 × 109/L (range, 90-272 × 109/L). The platelet count nadir resulting in cessation of chemotherapy was 45 × 109/L (range, 23-67 × 109/L), and the pre-PSAE platelet count was 88 × 109/L (range, 49-131 × 109/L). The post-PSAE peak platelet count improved significantly (to 209 × 109/L; range, 83-363 × 109/L) compared with the nadir counts and the pre-PSAE counts (P < .01) at a mean short-term follow-up of 35 days (range, 7-91 d). The counts at follow-up to 9.2 months (range, 3-15 mo) were 152 × 109/L (range, 91-241 × 109/L). All patients became eligible to resume chemotherapy. The time to initiation of chemotherapy after PSAE averaged 22 days (range, 4-58 d) in 12 patients; one patient declined chemotherapy. Conclusions: Proximal splenic artery embolization appears to be safe and effective in alleviating CIT, allowing resumption of systemic chemotherapy. Further studies may help guide patient selection by identifying characteristics that allow a sustained improvement in thrombocytopenia.",
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AU - Bhatia, Shivank

AU - Venkat, Shree

AU - Echenique, Ana

AU - Rocha-Lima, Caio

AU - Doshi, Mehul

AU - Salsamendi, Jason

AU - Barbery, Katuska

AU - Narayanan, Govindarajan

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N2 - Purpose: To determine if proximal splenic artery embolization (PSAE) provides a safe and effective alternative to alleviate chemotherapy-induced thrombocytopenia (CIT), allowing patients with cancer to resume chemotherapy regimens. Materials and Methods: Thirteen patients (9 men, 4 women; mean age, 63 y) with underlying malignancy (pancreatic adenocarcinoma, n = 6; cholangiocarcinoma, n = 5; other, n = 2) complicated by CIT underwent PSAE. Mean platelet counts were calculated before the initiation of chemotherapy, at the nadir that resulted in discontinuation of chemotherapy before the PSAE procedure, at peak values after the procedure, and at a mean follow-up of 9.2 months. The time to reinitiation of chemotherapy after PSAE was calculated. Results: Baseline platelet count before initiation of chemotherapy was 162 × 109/L (range, 90-272 × 109/L). The platelet count nadir resulting in cessation of chemotherapy was 45 × 109/L (range, 23-67 × 109/L), and the pre-PSAE platelet count was 88 × 109/L (range, 49-131 × 109/L). The post-PSAE peak platelet count improved significantly (to 209 × 109/L; range, 83-363 × 109/L) compared with the nadir counts and the pre-PSAE counts (P < .01) at a mean short-term follow-up of 35 days (range, 7-91 d). The counts at follow-up to 9.2 months (range, 3-15 mo) were 152 × 109/L (range, 91-241 × 109/L). All patients became eligible to resume chemotherapy. The time to initiation of chemotherapy after PSAE averaged 22 days (range, 4-58 d) in 12 patients; one patient declined chemotherapy. Conclusions: Proximal splenic artery embolization appears to be safe and effective in alleviating CIT, allowing resumption of systemic chemotherapy. Further studies may help guide patient selection by identifying characteristics that allow a sustained improvement in thrombocytopenia.

AB - Purpose: To determine if proximal splenic artery embolization (PSAE) provides a safe and effective alternative to alleviate chemotherapy-induced thrombocytopenia (CIT), allowing patients with cancer to resume chemotherapy regimens. Materials and Methods: Thirteen patients (9 men, 4 women; mean age, 63 y) with underlying malignancy (pancreatic adenocarcinoma, n = 6; cholangiocarcinoma, n = 5; other, n = 2) complicated by CIT underwent PSAE. Mean platelet counts were calculated before the initiation of chemotherapy, at the nadir that resulted in discontinuation of chemotherapy before the PSAE procedure, at peak values after the procedure, and at a mean follow-up of 9.2 months. The time to reinitiation of chemotherapy after PSAE was calculated. Results: Baseline platelet count before initiation of chemotherapy was 162 × 109/L (range, 90-272 × 109/L). The platelet count nadir resulting in cessation of chemotherapy was 45 × 109/L (range, 23-67 × 109/L), and the pre-PSAE platelet count was 88 × 109/L (range, 49-131 × 109/L). The post-PSAE peak platelet count improved significantly (to 209 × 109/L; range, 83-363 × 109/L) compared with the nadir counts and the pre-PSAE counts (P < .01) at a mean short-term follow-up of 35 days (range, 7-91 d). The counts at follow-up to 9.2 months (range, 3-15 mo) were 152 × 109/L (range, 91-241 × 109/L). All patients became eligible to resume chemotherapy. The time to initiation of chemotherapy after PSAE averaged 22 days (range, 4-58 d) in 12 patients; one patient declined chemotherapy. Conclusions: Proximal splenic artery embolization appears to be safe and effective in alleviating CIT, allowing resumption of systemic chemotherapy. Further studies may help guide patient selection by identifying characteristics that allow a sustained improvement in thrombocytopenia.

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