Chronic Granulocytic Leukaemia: Effect of Elective Splenectomy on the Course of Disease

Leukemic spleen cells are more potent than bone marrow-derived cells in a transgenic mouse model of CML

“…Several clinical trials have been conducted to investigate whether targeting the spleen in CML may alter the course of the disease. Although prolonged complete remissions have in fact been documented in the past using splenectomy in patients with CML, 21,22 these reports are anecdotal and have not led to implementation of splenectomy into the standard treatment of CML. However, these individual successes do suggest that the spleen can be the major site of disease in selected patients.…”

Eradication of the intramedullary Ph1 positive cell live without accompanying improved survival in chronic myelogenous leukemia

“…8 The preliminary results of one study are indicative of prolongation of survival in select patients postsplenectomy, and this is now being subjected to a randomized trial. 18 Another approach to prolong survival is to eradicate the Ph' positive cell line. The bases for this therapeutic rationale are: 1) in vitro semi-solid and liquid cultures of bone marrow may reveal the co-existence of Ph' negative granulocyte colonies, though direct marrow preparations are Phl positive.2 2) Long-term remissions secondary to busulfan therapy may be accompanied by the disappearance of the Ph'+ cell line.3,5 3) Occasional patients with Ph'+ CML have a small percentage of marrow cells with a normal karyotype.16 They appear to have a longer survival than those with 100% Ph'+ ~e1ls.l~ A patient with mosaicism for the Phl chromosome and an eight year unmaintained remission has been recently re-p~r t e d .~ 4) Chromosomal analyses of metaphase spreads during acute transformation reveal the persistence of the Ph' chromosome, implying that it is in this cell line that transformation occurs.…”

Indikation zur Splenektomie bei hämatologischen Erkrankungen*

“…Da die Blastenkrise zu den Erkrankungen mit äußerst schlechter Prognose gehört, kann die Operation zu einer therapeutischen Alternative werden, wenn sich die genannten positiven Beobachtungen bestätigen lassen. Ober günstige Ergebnisse der Splenektomie als prophylaktische Maßnahme zur Hinausschiebung der Blastenkrise ist kürzlich in einer Serie von 26 Patienten berichtet worden (23).…”