title: Splenic irradiation for prolymphocytic leukemia: is it preferable as an initial treatment or not?
abstract: We describe a case of B-cell prolymphocytic leukemia (PLL) successfully treated with splenic irradiation (SI). A 69-year-old woman was admitted to our hospital because of massive splenomegaly and leukocytosis. Peripheral blood showed hemoglobin (Hb) 7.4 g/dl, platelets 48 x 10(9)/l and white blood cells (WBC) 50.3 x 10(9)/l with 90% prolymphocytes. Bone marrow was hypercellular with 60% prolymphocytes. Surface marker analysis revealed that prolymphocytes were positive for CD20, CD22, FMC7, HLA-DR and surface immunoglobulin (mu, delta and lambda), but negative for CD5 and mouse erythrocyte rosette. A diagnosis of B-cell PLL was made. SI (1.5 Gy x 4/week, total dose 19.5 Gy) was chosen for the treatment and a remarkable response was achieved immediately after the first irradiation. Finally, a single course of SI induced complete remission without any significant side effect. One year after the SI, she showed no splenomegaly and almost normal peripheral blood cell count (Hb 11.2 g/dl, platelets 100 x 10(9)/l, WBC 3.6 x 10(9)/l with 71% neutrophils and no prolymphocyte). She has been well for more than 24 months. This case showed that SI may remain valuable for an initial course of PLL treatment.
authors.affiliation: Department of Hematology, Musashino Red Cross Hospital, Tokyo, Japan.
authors.forename: K
authors.initials: K
authors.lastname: Yamamoto
authors.forename: H
authors.initials: H
authors.lastname: Hamaguchi
authors.forename: K
authors.initials: K
authors.lastname: Nagata
authors.forename: H
authors.initials: H
authors.lastname: Shibuya
authors.forename: H
authors.initials: H
authors.lastname: Takeuchi
mesh_terms: D000368:Aged; D000954:Antigens, Surface / Q000097:blood; D014408:Biomarkers, Tumor / Q000097:blood; D005260:Female; D006801:Humans; D007136:Immunoglobulins / Q000032:analysis; D015463:Leukemia, Prolymphocytic / Q000276:immunology / Q000532:radiotherapy*; D011879:Radiotherapy Dosage; D013154:Spleen / Q000528:radiation effects*; D013163:Splenomegaly / Q000532:radiotherapy
chemical_list: D000954:Antigens, Surface; D014408:Biomarkers, Tumor; D007136:Immunoglobulins