Prognostic variables in hairy cell leukemia after splenectomy as initial therapy

Area of Science:

• Hematology
• Oncology

Background:

• Splenectomy has been a long-standing initial treatment for hairy cell leukemia (HCL).
• While effective for peripheral blood counts, its long-term efficacy varies, necessitating further therapies for many patients.

Purpose of the Study:

• To analyze prognostic factors influencing failure-free survival (FFS) after splenectomy in HCL patients.
• To identify patient subsets with different prognoses post-splenectomy to guide treatment decisions.

Main Methods:

• Retrospective analysis of 194 hairy cell leukemia patients who underwent initial splenectomy.
• Univariate and Cox regression analyses were used to identify significant prognostic variables for FFS.
• Patients were stratified into risk groups based on bone marrow cellularity and platelet count.

Main Results:

• Bone marrow cellularity (≥85%) and low platelet count (<60,000/microliters) were independent predictors of shorter FFS.
• Median FFS varied significantly: 56.5 months (low risk), 11.7 months (intermediate risk), and 5.4 months (high risk).
• Improved overall survival was observed in patients diagnosed after 1982 compared to earlier diagnoses.

Conclusions:

• Splenectomy remains a standard initial therapy for hairy cell leukemia.
• Patients with high bone marrow cellularity (≥85%) have a poor prognosis after splenectomy and may benefit from upfront systemic therapy.
• Prognostic stratification using bone marrow cellularity and platelet count can inform treatment strategies.