Splenectomy in leukemia: hematologic and clinical effects on 34 patients and review of 299 published cases.

Abstract

Summary With acquisition of an ever increasing number of more or less specific therapeutic agents, splenectomy in leukemia has been performed infrequently in more recent years. There remains, however, a small group of leukemic patients who may be substantially benefited by splenectomy. The result of splenectomy in 34 new patients is presented with a critical review of results obtained in a total of 299 cases collected from the literature. The criteria for splenectomy in leukemia and myelofibrosis are: (a) Ineffectiveness of other forms of therapy to control cytopenia, particularly anemia in the presence of a splenomegaly when the anemia, or cytopenia in general, is sufficiently severe to be a major element of illness. In such a state, splenectomy must be conditioned on evidence, by study of the bone marrow and by determination of the rate of turnover of red cells, that the production of red cells is at least normal, preferably if it is increased. (b) Intractable pain, referable to the size of the spleen, of such severity as to interfere with the patient9s welfare. Splenectomy is followed by a significant increase of platelets in myelofibrosis; by a significant increase in granulocytes in chronic lymphatic leukemia, in myelofibrosis, and in reticuloendotheliosis; by a significant increase in the hemoglobin level in chronic lymphatic leukemia and myelofibrosis. Clinically, splenectomy is more frequently effective in chronic lymphatic leukemia and in myelofibrosis; it is only occasionally effective in reticuloendotheliosis, including Hodgkin9s disease. It has no significant effect in patients of chronic myeloid leukemia.