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Splenectomy in advanced chronic lymphocytic leukemia: a single institution experience with 50 patients
T F Neal1, A Tefferi, T E Witzig
1Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota 55905.
Insights
Splenectomy effectively treats refractory cytopenias in advanced chronic lymphocytic leukemia (CLL), offering durable remissions and relieving splenomegaly with low mortality. This procedure improves blood counts, potentially enabling better chemotherapy administration.
Area of Science:
- Hematology
- Oncology
- Surgical Oncology
Background:
- Chronic lymphocytic leukemia (CLL) can lead to refractory cytopenias and symptomatic splenomegaly.
- Splenectomy is a potential treatment option for managing these complications in advanced CLL.
Purpose of the Study:
- To evaluate the effectiveness of splenectomy in treating cytopenias resistant to chemotherapy in patients with advanced CLL.
- To assess the operative risks and long-term outcomes associated with splenectomy for CLL.
Main Methods:
- Retrospective review of 57 patients with CLL who underwent splenectomy between 1975 and 1991.
- Analysis focused on 50 patients who had splenectomy for cytopenias or splenomegaly, assessing response, morbidity, and mortality.
Main Results:
- Splenectomy achieved positive responses in 77% with anemia, 70% with thrombocytopenia, and 64% with both, with sustained responses at 1 year.
- Operative morbidity was 26% and mortality was 4%. Median survival was 41 months for responders versus 14 months for non-responders.
- No preoperative factors predicted poor hematologic response; splenomegaly relief was consistent.
Conclusions:
- Splenectomy is an effective treatment for refractory cytopenias and symptomatic splenomegaly in CLL patients.
- The procedure offers durable remissions with low perioperative mortality.
- Improved blood counts post-splenectomy may facilitate chemotherapy administration.
Purpose:
To assess the efficacy of splenectomy in the treatment of refractory cytopenias associated with advanced chronic lymphocytic leukemia (CLL).
Patients And Methods:
The histories of 57 patients with CLL who underwent splenectomy at the Mayo Clinic between 1975 and 1991 were retrospectively reviewed. Of the 57 patients, 50 underwent splenectomy for reasons directly related to their disease process such as cytopenias or symptomatic splenomegaly. The histories from these 50 patients were studied to assess the response to splenectomy and the operative morbidity and mortality.
Results:
Ninety-four percent of patients were in Rai stage III or IV with extensive marrow infiltration, massive splenomegaly, and cytopenias refractory to chemotherapy. A positive response to splenectomy was defined at 3 months of follow-up as: (1) a hemoglobin level of 11 g/dL or greater in a patient with a preoperative value less than 11 g/dL; or (2) a platelet count of 100 x 10(3)/mm3 or greater in a patient with a preoperative value less than 100 x 10(3)/mm3. A positive response was achieved in 77% of patients with anemia, 70% of patients with thrombocytopenia, and 64% of patients with both anemia and thrombocytopenia. The response was sustained at 1 year of follow-up in 86%, 84%, and 85% of the patients, respectively. Postoperative transfusion requirements decreased correspondingly. The operative morbidity was 26%, and the operative mortality was 4%. The mean duration of hospitalization was 9.8 days (median: 9 days; range: 5 to 24 days). The actuarial median survival after splenectomy was 41 months in responders and 14 months in nonresponders. We found no preoperative parameters that were clearly predictive of a poor hematologic response. In particular, outcome was not affected by preoperative spleen size or the degree of marrow infiltration by CLL. All patients with symptomatic splenomegaly had an improved sense of well-being.
Conclusion:
In this, the largest single institution study to date, we found splenectomy to be efficacious in providing durable remissions of refractory cytopenias and in relieving symptomatic splenomegaly in the majority of patients with CLL. The procedure is associated with a low perioperative mortality. Although the impact on survival is uncertain, the improved peripheral blood counts may allow the administration of adequate doses of myelosuppressive chemotherapy.