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

Abstract

The purpose of this study was to define the role of splenectomy in patients (pts) with mantle cell lymphoma (MCL) with regard to improving cytopenias and symptoms of splenomegaly. 26 pts with MCL underwent splenectomy between January 1987 and October 1999 and were followed prospectively for hematologic response and operative morbidity and mortality. A positive response was defined at 1 month of follow-up as: a hemoglobin of > or = 1.0 g/dl in a pt with a preoperative value < 11.0 g/dl; or a platelet count of > or = 100 x 10(9)/L in a pt with a preoperative value < 100 x 10(9)/L. A positive hematologic response was achieved in 69.2% of pts with preoperative anemia, 90% with thrombocytopenia, and 50% with both anemia and thrombocytopenia. The peri- and post-operative morbidity were 3.8 and 19.2%, respectively, the operative mortality was 0%. The median duration of hospitalization was six days. Four (15.4%) pts have not required chemotherapy after splenectomy. Three of these four were previously untreated and they have maintained stable disease for eight years after splenectomy without chemotherapy. Eight additional pts did not require chemotherapy for > 13 months after splenectomy. These results suggest that splenectomy may provide durable remission in selected pts with refractory cytopenias or symptoms related to splenomegaly in pts with MCL. There is a subset of pts that have prolonged disease stabilization without the requirement for immediate chemotherapy after splenectomy.

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

“…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.…”

“…Despite this, half of the patients with MCL and leukaemia had prolonged treatment-free periods after splenectomy. Yoong et al (2001) reported similar results in their patients with MCL; four out of 26 patients did not require further therapy post splenectomy, with a mean follow up of 95AE4 months, and eight additional patients did not require therapy for over a year, with a median time to treatment of 28 months.…”

“…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.…”

“…A positive effect of splenectomy on survival in chronic lymphocytic leukaemia (CLL) has been documented in a number of studies (Christensen et al, 1977;Delpero et al, 1987;Gallhofer et al, 1987;Pegourie et al, 1987;Stein et al, 1987;Delpero et al, 1990;Thiruvengadam et al, 1990;Majumdar & Singh, 1992;Neal et al, 1992;Coad et al, 1993;Cusack et al, 1997;Seymour et al, 1997), but its indication in CLL has been considered largely palliative, aiming to improve cytopenias and the symptoms of splenomegaly. Splenectomy in mantle cell lymphoma (MCL) has been mainly anecdotal (Coad et al, 1993;Vadlamudi et al, 1996;Oinonen et al, 1997;Bertini et al, 1998;Samaha et al, 1998;Mollejo et al, 1999;Soria Aledo et al, 1999;Strickland et al, 2001) except for a series just published (Yoong et al, 2001). Most patients with cytopenia experience improvements in their blood counts after splenectomy.…”

Splenectomy in the Treatment of Mantle Cell Lymphoma

“…Спленектомія не розглядається як лікувальна опція у рекомендаціях ESMO з лікування MCL [2,11]. Проте в літературі є повідомлення про добрі безпосередні та віддалені результати спленектомії при MCL [7,8,12]. Такі повідомлення поодинокі, а кількість прооперованих хворих не надто велика, що зумовлено насамперед низькою частотою цієї лімфоми.…”