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Case/control study of the role of splenectomy in chronic lymphocytic leukemia
J F Seymour1, J D Cusack, S A Lerner
1Department of Clinical Haematology and Medical Oncology, Royal Melbourne Hospital, Australia.
Insights
Splenectomy offers modest risks and significant hematologic benefits for chronic lymphocytic leukemia patients, particularly those with thrombocytopenia. Survival outcomes were comparable to controls, suggesting potential survival advantages in advanced stages.
Area of Science:
- Hematology
- Oncology
- Surgical Oncology
Background:
- Chronic lymphocytic leukemia (CLL) is a common hematologic malignancy.
- Splenectomy is a therapeutic option for managing cytopenias and splenomegaly in CLL.
- Evaluating the risks and benefits of splenectomy in CLL is crucial for treatment planning.
Purpose of the Study:
- To assess the morbidity and mortality associated with splenectomy in CLL patients.
- To determine the likelihood of hematologic response post-splenectomy.
- To evaluate the impact of splenectomy on overall survival using a case/control design.
Main Methods:
- Retrospective analysis of 55 CLL patients who underwent splenectomy (1971-1993).
- Comparison with 55 matched fludarabine-treated CLL patients.
- Multivariate analysis to identify predictors of survival and hematologic response.
Main Results:
- Splenectomy demonstrated modest perioperative morbidity (infections 18%, pneumonia/atelectasis 25%) and 9% perioperative mortality.
- Spleen weight predicted hemoglobin and neutrophil increments; no predictor for platelet increment was found.
- No significant difference in early or overall survival between splenectomy and control groups (P > .2).
- Rai stage IV patients showed a trend towards improved survival after splenectomy (2-year survival 51% vs. 28%).
Conclusions:
- Splenectomy is feasible in advanced CLL with significant cytopenias, offering hematologic benefits and manageable risks.
- Hematologic improvements, particularly in hemoglobin and neutrophils, correlate with spleen weight.
- Thrombocytopenic CLL patients may experience the greatest hematologic benefit and potential survival improvement, warranting further randomized study.
Purpose:
This retrospective analysis was performed to evaluate critically the morbidity and mortality of splenectomy in patients with chronic lymphocytic leukemia and to determine the probability of hematologic response. Further, using a case/control format based on multivariate analysis-derived predictors of survival, we evaluated the influence of splenectomy on survival.
Patients And Methods:
Between 1971 and 1993, 55 patients with chronic lymphocytic leukemia underwent splenectomy. They were compared with 55 fludarabine-treated patients who had been matched for age, serum albumin level, sex, hemoglobin level, Rai stage, number of prior therapies, and time from diagnosis.
Results:
In the perioperative period, blood-product usage was modest, and common morbidities were limited to minor infections in 18% of the patients and pneumonia/atelectasis in 25%. Perioperative mortality was 9%. Deaths were related to septic complications in all cases and associated with a preoperative performance status > or = 2 (P = .05). The only predictor identified for hemoglobin and neutrophil increments was spleen weight (P < .05). No factors predictive of platelet increment were identified. The early death rate (within 30 days) and overall survival of splenectomy and control patients were not significantly different (P > .2). Among Rai stage IV patients, those who were splenectomized displayed a strong trend for improved overall survival (P = .15 by log-rank test). The 2-year actuarial survival rate of Rai stage IV patients was 51% +/- 9% in the splenectomy group and 28% +/- 9% in the control group.
Conclusion:
Splenectomy can be performed with modest morbidity, mortality, and resource utilization in patients with advanced chronic lymphocytic leukemia and significant cytopenias. The procedure results in major hematologic benefits in most patients, with hemoglobin and neutrophil increments correlated with spleen weight. Overall, the survival of splenectomized patients is equivalent to control patients. Thrombocytopenic patients (< 100 x 10(9)/L) are most likely to obtain hematologic benefit, and potentially enjoy improved survival. These patients would be suitable for a randomized study to establish definitively the role of splenectomy in chronic lymphocytic leukemia.