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Splenectomy for patients with myelofibrosis with myeloid metaplasia: pretreatment variables and outcome prediction
G Barosi1, A Ambrosetti, A Buratti
1Dipartimento di Medicina Interna e Terapia Medica, IRCCS Policlinico S. Matteo, Pavia, Italy.
Abstract:
Since according to the early studies, the outcome after splenectomy in the individual patient with myelofibrosis with myeloid metaplasia (MMM) is unpredictable, we assessed retrospectively the pre-intervention characteristics that best predicted adverse events, hematological consequences, and survival in 71 splenectomized MMM patients. The findings indicate that the operative risk of splenectomy for both mortality (8.4%) and morbidity (39.3%) was unpredictable. New hemorrhagic or thrombotic complications occurred in 16.9% of surviving patients and were predicted by age < 50 years, a normal to high platelet count (> 200 x 10(9)/l) and huge splenomegaly (> 16 cm from the costal margin). Massive liver enlargement occurred in 24% of patients and has to be expected in patients splenectomized for transfusion-dependent anemia. Anemia improved substantially in 45% and 52% of patients at 3 months and at 1 year, respectively, and was predicted by severe anemia, low platelet count (< 100 x 10(9)/l) or normal to high white blood cell (WBC) count (> 4 x 10(9)/l). Survival from splenectomy was superior in patients < 45 years with WBC < 10 x 10(9)/l count. An unexpectedly high rate of blastic transformation was observed. It accounted for 42.8% of the deaths. The results suggest trials for prophylactic cytoreductive treatment in young patients and when platelet count is normal to increased. Further study is needed for elucidating the possible role played by splenectomy in inducing blastic transformation.
Insights
Splenectomy outcomes in myelofibrosis with myeloid metaplasia (MMM) are unpredictable. Pre-intervention factors like age and platelet count influence complications and survival, with high rates of blastic transformation observed.
Area of Science:
- Hematology
- Oncology
Background:
- Myelofibrosis with myeloid metaplasia (MMM) outcomes post-splenectomy are variable.
- Early studies show unpredictable results for splenectomy in MMM patients.
Purpose of the Study:
- To retrospectively identify pre-intervention characteristics predicting adverse events, hematological changes, and survival in splenectomized MMM patients.
- To analyze operative risks, complications, and long-term outcomes following splenectomy for MMM.
Main Methods:
- Retrospective analysis of 71 patients with MMM who underwent splenectomy.
- Assessment of pre-intervention characteristics, operative mortality and morbidity, and post-splenectomy complications.
- Evaluation of hematological parameters, liver enlargement, and survival rates.
Main Results:
- Operative mortality was 8.4% and morbidity 39.3%.
- Hemorrhagic/thrombotic complications (16.9%) predicted by age < 50, high platelets, and huge splenomegaly.
- Anemia improved in 45% (3 months) and 52% (1 year), predicted by severe anemia or specific WBC/platelet counts.
- Massive liver enlargement occurred in 24%, especially in transfusion-dependent anemia.
- Blastic transformation accounted for 42.8% of deaths.
Conclusions:
- Splenectomy in MMM carries unpredictable risks and variable outcomes.
- Specific patient characteristics predict complications and hematological response.
- High rates of blastic transformation warrant further investigation and suggest potential prophylactic treatments.