Clinical and immunological evaluation of primary splenic irradiation in chronic lymphocytic leukemia: a study of 24 cases

Abstract

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.

Treatment of symptomatic splenomegaly with low doses of radiotherapy: Retrospective analysis and review of the literature

“…Kriz et al [32] analyzed 122 hematologic patients [4,30,31]. Radiotherapy takes place usually in refractory splenomegaly or when the patient refuses other treatments [21][22][23][24][25][26][27][28], although we consider it should be used sooner in the natural history of this affection. Cervantes et al [35], refuse treatment because it is not durable, but in some studies it is demonstrated the possibility to repeat treatment with similar toxicity as the first time.…”

Guidelines on the diagnosis and management of chronic lymphocytic leukaemia

“…Cytopenia is not, however, a contraindication to therapy as all haematological indices generally improve following a response to radiotherapy (Chisesi et al , 1991). Remarkably low doses of irradiation may be effective and doses of 0·5–1 Gray (Gy) one to three times per week has become the conventional practice, as no significant dose response is seen above 10 Gy (Van Mook et al , 2001).…”

Low‐dose palliative splenic irradiation in haematolymphoid malignancy

“…Patients not tolerating or responding to chemotherapy and unsuitable for splenectomy are the usual recipients of this treatment. Palliative SI continues to be used in a multitude of conditions, including CLL, 2–11 PLL, 16,24 hairy cell leukaemia (HCL), 13 splenic marginal zone lymphoma 14,15 and myeloproliferative disorders, including CML and myelofibrosis (Table 5). 2–4,16–23 The indications for which palliative SI was used at our centre closely matches this list (Table 1).…”