Splenectomy in lymphoproliferative disorders: a report on 70 cases and review of the literature.
Between February, 1970 and September, 1991, we performed splenectomies on 70 patients with chronic lymphoproliferative disorders including primary leukemias: 19 B-cell chronic lymphocytic leukemia, 1 B-cell prolymphocytic leukemia, 22 hairy cell leukemias, 4 large granular lymphocytic leukemias, 1 T-cell prolymphocytic leukemia, and non-Hodgkin's lymphomas (NHL): 10 splenic lymphomas with villous lymphocytes, 4 follicular lymphomas, 5 mantle cell lymphomas, 3 lymphoplasmacytic and 1 large cell NHL. The primary indications for surgery in this series were therapy-resistant disease (40%) and therapeutic splenectomy (38%). Postsplenectomy, 70% of patients had a complete hematological response, 23% had a partial response, and 7% were nonresponsive. Median treatment-free survival correlated with the hematologic response postsplenectomy and the underlying diagnosis. Better treatment-free survivals were seen in patients with lesser degrees of anemia and thrombocytopenia. Overall, improvements were more pronounced in the B-cell than in the T-cell disorders. Indications for further therapy, postoperative morbidity and mortality, and survival times are discussed along with a review of the literature. These findings advocate a continuing role for splenectomy in symptomatic lymphoid malignancies running with splenomegaly and hypersplenism.
Coad
J E
JE
Academic Department of Hematology and Cytogenetics, Royal Marsden Hospital, London, England, UK.
Matutes
E
E
Catovsky
D
D
D000328:Adult; D000368:Aged; D000744:Anemia, Hemolytic, Autoimmune / Q000601:surgery; D003131:Combined Modality Therapy; D005260:Female; D006801:Humans; D007938:Leukemia / Q000097:blood / Q000145:classification / Q000401:mortality / Q000601:surgery / Q000628:therapy; D008228:Lymphoma, Non-Hodgkin / Q000401:mortality / Q000601:surgery; D008232:Lymphoproliferative Disorders / Q000097:blood / Q000401:mortality / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D012074:Remission Induction; D012189:Retrospective Studies; D013156:Splenectomy; D016019:Survival Analysis; D016896:Treatment Outcome