0 1992 Harwood
Academic Publishers GmbH Printed in the United Kingdom
Leukemia and Lymphoma, Vol. I , pp. 131-134 Reprints available directly from the publisher Photocopying permitted by license only
Leuk Lymphoma Downloaded from informahealthcare.com by Cornell University on 12/28/14 For personal use only.
Role of Splenectomy in Chronic Lymphocytic Leukaemia With Massive Splenomegaly and Cytopenia G. MAJUMDAR and A. K. SINGH Division of Haematology, UMDS, St. Thomas’ Campus, London, England. (Received 8 November 1991)
Fourteen cases of chronic lymphocytic leukaemia (CLL) and massive splenomegaly associated with anaemia and/or thrombocytopenia (stage C) with or without mechanical distress underwent splenectomy. Eleven regressed to stage A and 2 to stage B. All 6 patients with mechanical distress were relieved of their symptoms. Among 13 patients with anaemia, haemoglobin (Hb) level was normalised in 3, improved in 8 and showed no change in 2 cases. Among 13 patients with thrombocytopenia, platelet count was normalised in 10, improved in 1 and was unchanged in 2 cases. Mean Hb level increased from 89 g/l to 125 g/l and mean platelet count from 77 x 109/1 to 241 x lo9) (p < 0.001 for both). Duration of response lasted for a mean period of 42.1 (CI 20.8-63.5) months. Mean survival after splenectomy was 44.5 months (CI 21.2-67.7). There was no operative mortality but 4 patients had significant post-operative morbidity. It is concluded that splenectomy is beneficial in advanced cases of CLL with massive splenomegaly and cytopenia. KEY WORDS:
INTRODUCTION
Splenectomy
CLL
massive splenomegaly
PATIENTS AND RESULTS
Massive splenomegaly is a common problem in the Diagnosis of CLL was made in all 14 patients by full late stages of CLL and is usually associated with blood count, bone marrow aspiration and trephine anaemia, thrombocytopenia and in some cases biopsy together with cell surface markers. All had physical distress due to the mechanical effects. The B-cell CLL. Tables 1 and 2 show the clinical and pathology is massive infiltration of the splenic laboratory data. Six patients were diagnosed at stage parenchyma with tumour cells, causing hypersplenism C and others at earlier stages who progressed to stage in some cases. The disease at this stage is usually C. None of the patients had a positive direct refractory to chemotherapy and radiotherapy and anti-globulin test or other evidence of autoimmune severe cytopenias often preclude their use. Sple- haemolytic anaemia. nectomy has been used successfully in such cases for At the time of operation 12 patients had Hb amelioration of cytopenias and physical symptoms < lOOg/l and only one had a normal Hb. Eight of these though its effect on survival is not clear’,’. We report patients were transfusion dependent. Post-operatively clinical and survival data of 14 such patients who only one patient required continued transfusion underwent splenectomy. support. Ten patients had platelet counts
Academic Publishers GmbH Printed in the United Kingdom
Leukemia and Lymphoma, Vol. I , pp. 131-134 Reprints available directly from the publisher Photocopying permitted by license only
Leuk Lymphoma Downloaded from informahealthcare.com by Cornell University on 12/28/14 For personal use only.
Role of Splenectomy in Chronic Lymphocytic Leukaemia With Massive Splenomegaly and Cytopenia G. MAJUMDAR and A. K. SINGH Division of Haematology, UMDS, St. Thomas’ Campus, London, England. (Received 8 November 1991)
Fourteen cases of chronic lymphocytic leukaemia (CLL) and massive splenomegaly associated with anaemia and/or thrombocytopenia (stage C) with or without mechanical distress underwent splenectomy. Eleven regressed to stage A and 2 to stage B. All 6 patients with mechanical distress were relieved of their symptoms. Among 13 patients with anaemia, haemoglobin (Hb) level was normalised in 3, improved in 8 and showed no change in 2 cases. Among 13 patients with thrombocytopenia, platelet count was normalised in 10, improved in 1 and was unchanged in 2 cases. Mean Hb level increased from 89 g/l to 125 g/l and mean platelet count from 77 x 109/1 to 241 x lo9) (p < 0.001 for both). Duration of response lasted for a mean period of 42.1 (CI 20.8-63.5) months. Mean survival after splenectomy was 44.5 months (CI 21.2-67.7). There was no operative mortality but 4 patients had significant post-operative morbidity. It is concluded that splenectomy is beneficial in advanced cases of CLL with massive splenomegaly and cytopenia. KEY WORDS:
INTRODUCTION
Splenectomy
CLL
massive splenomegaly
PATIENTS AND RESULTS
Massive splenomegaly is a common problem in the Diagnosis of CLL was made in all 14 patients by full late stages of CLL and is usually associated with blood count, bone marrow aspiration and trephine anaemia, thrombocytopenia and in some cases biopsy together with cell surface markers. All had physical distress due to the mechanical effects. The B-cell CLL. Tables 1 and 2 show the clinical and pathology is massive infiltration of the splenic laboratory data. Six patients were diagnosed at stage parenchyma with tumour cells, causing hypersplenism C and others at earlier stages who progressed to stage in some cases. The disease at this stage is usually C. None of the patients had a positive direct refractory to chemotherapy and radiotherapy and anti-globulin test or other evidence of autoimmune severe cytopenias often preclude their use. Sple- haemolytic anaemia. nectomy has been used successfully in such cases for At the time of operation 12 patients had Hb amelioration of cytopenias and physical symptoms < lOOg/l and only one had a normal Hb. Eight of these though its effect on survival is not clear’,’. We report patients were transfusion dependent. Post-operatively clinical and survival data of 14 such patients who only one patient required continued transfusion underwent splenectomy. support. Ten patients had platelet counts
