Clinical and immunological evaluation of primary splenic irradiation in chronic lymphocytic leukemia: a study of 24 cases.
Little is known about the effects of primary splenic irradiation (SI) in B-cell chronic lymphocytic leukemia (B-CLL) on subpopulations of lymphocytes, immunoglobulins, and the induction of autoantibodies against erythrocytes and platelets. Twenty-four untreated patients with B-CLL were studied prospectively. One patient was excluded from analysis because of intercurrent death. Of the remaining 23 patients, 7 were female and 16 were male, with an average age of 68.4 and 61.2 years, respectively. Treatment consisted of a weekly dose of I Gy up to a total dose of 10 Gy to the spleen. Standardized evaluation was done 2 weeks before and 6 weeks after SI. Twenty patients completed the course of SI. In 14 patients there was a partial response and in 9 patients the disease remained stable. The number of leukocytes decreased rapidly and significantly, with a decrease in the fraction of lymphocytes and an increase in the neutrophil count (all P<0.0001). There was a significant increase in platelet count, but not in hemoglobin level. Nausea, slight diarrhea, pleuropneumonia, granulopenia with fever (all n=1), urinary tract infection and high fever (n=1), and thrombocytopenia occurred (n=2). One patient received transfusion of packed cells because of upper digestive tract bleeding for which cessation of SI was not necessary. The number of malignant cells showed a significant decrease (P<0.01). No significant changes in CD4/CD8 ratio were found. The number of CD4+ and CD8+-cells, however, decreased significantly (P<0.01 and 0.03, respectively). DAT remained unchanged in most (93%) and tests for antibodies to platelets in 83% of the patients. No significant changes in immunoglobin levels were observed.
van Mook
W N
WN
Department of Internal Medicine, Atrium Medical Center, Heerlen, NL.
Fickers
M M
MM
Verschueren
T A
TA
D000368:Aged; D001323:Autoantibodies / Q000097:blood; D001792:Blood Platelets / Q000276:immunology; D016516:CD4-CD8 Ratio; D004912:Erythrocytes / Q000276:immunology; D005260:Female; D006454:Hemoglobins / Q000032:analysis; D006801:Humans; D007070:Immunoglobulin A / Q000097:blood; D007074:Immunoglobulin G / Q000097:blood; D007075:Immunoglobulin M / Q000097:blood; D015451:Leukemia, Lymphocytic, Chronic, B-Cell / Q000276:immunology / Q000532:radiotherapy*; D007958:Leukocyte Count; D018655:Lymphocyte Count; D008297:Male; D008875:Middle Aged; D009504:Neutrophils; D010976:Platelet Count; D011446:Prospective Studies; D011878:Radiotherapy / Q000009:adverse effects; D013154:Spleen / Q000276:immunology / Q000473:pathology / Q000528:radiation effects*
D001323:Autoantibodies; D006454:Hemoglobins; D007070:Immunoglobulin A; D007074:Immunoglobulin G; D007075:Immunoglobulin M