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Editorials
splenectomy as treatment. The disease phase was also not defined in relation to outcomes. Additional limita- tions include potential selection bias related to the affilia- tion with the registry. In addition, the follow-up of the patients was limited to 25 months due to patient reten- tion. It would be important to understand more long- term outcomes (i.e., decades) regarding relapse of disease in adulthood, as well as infectious risk. It may never be possible to conduct randomized trials; however, longitu- dinal tracking of patients requiring second-line therapy provides the opportunity for indirect comparison. Application of patient-related outcomes in prospective trials may also help to capture factors that matter to patients besides platelet count and help in decision-mak- ing.
Despite the unanswered questions and known limita- tions associated with a registry, the work by Avila et al. provides insight into the long-term outcomes associated with splenectomy in children with ITP. The authors are to be commended for the long-term follow-up and collec- tion of data on a rare group of patients. These data give rise to an important consideration of the safe use of splenectomy to achieve remission in the majority of patients who have undergone this procedure, in spite of the decreasing numbers of patients over time in favor of therapies with presumably fewer life-long side-effects.
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