Efficacy of Splenectomy for Patients with Mantle Cell Non-Hodgkin's Lymphoma

Yoong, Yinlee; Kurtin, Paul J.; Allmer, Cristine; Geyer, Susan; Habermann, Thomas M.; Nagorney, David M.; Witzig, Thomas E.

doi:10.1080/10428190127511

Cited by 16 publications

(8 citation statements)

References 24 publications

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“…A high proportion of MCL and CLL patients (used as a comparative group) with cytopenias showed an improved haemoglobin and platelet count after splenectomy similar to the rates previously reported (Delpero et al , 1987; Gallhofer et al , 1987; Stein et al , 1987; Thiruvengadam et al , 1990; Majumdar & Singh, 1992; Neal et al , 1992; Coad et al , 1993; Pegourie‐Bandelier et al , 1995; Cusack et al , 1997; Yoong et al , 2001). A difference was seen in the response of the leucocytosis in MCL, where the leucocyte count showed a downward trend after splenecctomy, in some cases persisting for long periods.…”

Section: Discussionsupporting

confidence: 82%

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Splenectomy in mantle cell lymphoma with leukaemia: a comparison with chronic lymphocytic leukaemia

Ruchlemer

Wotherspoon²,

Thompson

et al. 2002

Br J Haematol

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We reviewed data on 63 patients with mantle cell lymphoma (MCL) with leukaemia (n = 16) and chronic lymphocytic leukaemia (CLL, n = 47), splenectomized over a 10-year period. Primary indications for surgery were cytopenia(s) or autoimmune phenomena and progressive or refractory disease with splenomegaly. The spleens removed were on average larger in MCL (median 2.6 kg) than in CLL (1.0 kg). Splenectomy improved the blood counts in 62% of patients with MCL and 47% with stage C CLL, both with cytopenias. The MCL patients showed a decrease in the leucocytosis (medians 60.3-29.1 x 10(9)/l before and after splenectomy), whereas there was an increase in the leucocytosis in CLL (medians 24.2-44 x 10(9)/l). With a median follow up post splenectomy of 10 months (range: < 1-128), 18 patients (four MCL and 14 CLL) have not required further therapy for up to 66 months. We conclude that splenectomy is a useful treatment in MCL and advanced CLL for the correction of cytopenias, reducing the leucocyte count and allowing prolonged periods of clinical remission without therapy. Differences seen between MCL and CLL in spleen size, and in response of the leucocytosis suggest a central role for the spleen in the evolution of MCL with leukaemia.

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Section: Discussionsupporting

confidence: 82%

“…The leucocyte count has been reported to increase in patients with CLL after splenectomy (Delpero et al , 1990; Majumdar & Singh, 1992; Neal et al , 1992; Coad et al , 1993). In the series reported by Yoong et al (2001) on splenectomy in MCL, there was no significant change in the leucocyte count.…”

Section: Discussionmentioning

confidence: 81%

Splenectomy in mantle cell lymphoma with leukaemia: a comparison with chronic lymphocytic leukaemia

Ruchlemer

Wotherspoon²,

Thompson

et al. 2002

Br J Haematol

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“…1 The disease is commonly advanced at presentation, with extranodal and bone marrow involvement. 4 It is important to note that 15% of these patients did not require chemotherapy afterward, including three patients who were previously untreated and had stable disease for 8 years after splenectomy. 3 In retrospect, this patient had MCL evident 10 years before it presented clinically as proven definitively by demonstrating both the t(11;14) and an identical immunoglobulin sequence in the splenic tissue.…”

Section: Discussionmentioning

confidence: 99%

Indolent Mantle-Cell Lymphoma: Immunoglobulin Variable Region Heavy Chain Sequence Analysis Reveals Evidence of Disease 10 Years Prior to Symptomatic Clinical Presentation

Rule

Poplar

Evans

et al. 2011

JCO

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We report on a 60-year-old man who presented as an emergency with an acute abdomen in 2003. He had been completely well until shortly before this presentation with no symptoms of note; specifically, he described no weight loss, no night sweats, no fevers, and no change in bowel habit. Apart from the obvious acute abdomen, clinical examination was unremarkable. There was no peripheral lymphadenopathy and no hepatomegaly, and it was noted that the man had previously had a splenectomy. At presentation, routine blood analysis was normal apart from a lymphocytosis of 19.8 ϫ 10 9 /L. The patient underwent an emergency laparotomy. During the operation, he was found to have a perforated duodenum and several large periduodenal lymph nodes. These were biopsied, and he underwent a gastrojejunostomy. The duodenum had perforated through a macroscopic tumor.The resected duodenum and lymph node biopsy obtained during the operation showed a nodular infiltrate of small lymphoid cells with irregular nuclei and inconspicuous cytoplasm, interspersed with histiocytes with copious cytoplasm. The cells were strongly CD20 ϩ , CD3 Ϫ , and CD5 ϩ and demonstrated nuclear expression of Cyclin D1 protein. Flow cytometric analysis of the circulating lymphocytes revealed a clonal population of B cells that were positive for CD19, CD5, CD23, CD79b, and FMC7 and were strongly positive for Lambda surface immunoglobulin. This was all consistent with a diagnosis of mantle-cell lymphoma (MCL). Fluorescent in situ hybridization (FISH) analysis using an IGH/CCND1 dual-color fusion probe set from Abbott Laboratories (Abbott Park, IL) demonstrated a t(11; 14)(q13:q32) translocation. Staging computed tomography revealed widespread lymphadenopathy, including in the mediastinal, retrocrural, and para-aortic regions, with subhepatic soft tissue masses of up to 3.5 cm. His bone marrow was heavily infiltrated with disease.After recovery from the operation, the patient was treated within a United Kingdom national MCL trial and entered complete remission. Treatment was with oral fludarabine and cyclophosphamide. Four years later, he developed acute myeloid leukemia while still in complete remission of lymphoma and unfortunately died as a result.Review of his notes shows that, in 1993, 10 years before diagnosis, the patient had been admitted to the hospital with an episode of severe abdominal pain. In addition, he had recently lost weight but had no other symptoms. His full blood count revealed a mild thrombocytopenia (78 ϫ 10 9 /L) with normal hemoglobin (15.9 g/dL) and lymphocyte counts (1.32 ϫ

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“…The degree of cytopenia may interfere with systemic therapy and, in some cases, splenomegaly is the dominant feature of the disease. In a series of 26 cases splenectomy has been shown to result in an improvement in hemoglobin by at least 1 g/dl in patients presenting with hemoglobin <11.0 g/dl in 69% of cases, with 90% of patients with a preoperative platelet count <100 3 10 9 /l achieving a platelet count of 100 3 10 9 /l by 1 month after surgery [Yoong et al 2001]. For those with anemia and thrombocytopenia the response rate was 50%.…”

Section: Early Stage Diseasementioning

confidence: 94%

Initial therapy of mantle cell lymphoma

Inwards¹,

Witzig²

2011

Therapeutic Advances in Hematology

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Mantle cell lymphoma is a well-recognized distinct clinicopathologic subtype of B-cell non-Hodgkin lymphoma. The current World Health Organization (WHO) classification subdivides this entity into aggressive and other variants. The disease has a predilection for older males, and patients typically present at an advanced stage with frequent splenomegaly and extranodal involvement including bone marrow, peripheral blood, gastrointestinal, and occasional central nervous system involvement. Early studies of therapy outcomes in this disease revealed that while response rates where high, relapse was expected after a limited period of time. Prolonged survival was uncommon, with initial median survival rates typically in the 3-4-year range. Those with a high proliferative rate, blastoid morphology, and selected clinical features were recognized as having a worse prognosis. Therapeutic approaches have diverged into aggressive therapies with high response rates and promising progression free survival rates, which may be applied to younger healthy patients, and less aggressive approaches. Aggressive therapies include intensive chemotherapy alone or chemotherapy followed by autologous stem cell transplant, which has been shown to be most effective when applied in first remission. Whether these more intense therapies result in improved survival as compared with less aggressive therapies is not well established. Allogeneic transplant has also been investigated, although high treatment-related mortality and the risk of chronic graft versus host disease and the relatively advanced age of this patient population have tempered enthusiasm for this approach. A number of less aggressive therapies have been shown to produce promising results. Consolidation and maintenance strategies are an active area of investigation. A number of newer agents have shown promising activity in relapsed disease, and are being investigated in the front-line setting. Overall survival rates are improving in this disease, with current studies suggesting a median survival of 5 or more years.

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Efficacy of Splenectomy for Patients with Mantle Cell Non-Hodgkin's Lymphoma

Cited by 16 publications

References 24 publications

Splenectomy in mantle cell lymphoma with leukaemia: a comparison with chronic lymphocytic leukaemia

Splenectomy in mantle cell lymphoma with leukaemia: a comparison with chronic lymphocytic leukaemia

Indolent Mantle-Cell Lymphoma: Immunoglobulin Variable Region Heavy Chain Sequence Analysis Reveals Evidence of Disease 10 Years Prior to Symptomatic Clinical Presentation

Initial therapy of mantle cell lymphoma

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