Spleen irradiation in chronic lymphocytic leukemia (CLL): Palliation in patients unfit for splenectomy

Aabo, Kristian; Walbom-Jørgensen, S.

doi:10.1002/ajh.2830190210

Cited by 24 publications

(10 citation statements)

References 5 publications

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“…Although lower doses can be sufficient for palliation, higher doses are also suggested in the literature (maximum doses of 24 Gy to 32 Gy) [16–19]. In this particular case, we used 27 Gy in order to achieve better hematologic parameters.…”

Section: Discussionmentioning

confidence: 99%

Palliative splenic irradiation for symptomatic splenomegaly in non-Hodgkin lymphoma

Oliveira¹,

Fardilha²,

Louro³

et al. 2018

ecancer

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Introduction and aimsSplenic marginal zone lymphoma, an uncommon subtype of non-Hodgkin lymphoma (NHL), is usually present with symptomatic splenomegaly. Although splenectomy has long been considered the first-line therapy in symptomatic or cytopenic patients, it can lead to significant morbidity and mortality. Splenic irradiation is an option for patients who have a poor response to systemic therapy and/or are not surgical candidates. In this paper, we present a case report of a patient who received splenic radiotherapy for symptomatic splenomegaly.MethodsAn 85-year-old Caucasian man with a 4 year history of low-grade NHL presented with progressive pancytopenia, significant weight loss and symptomatic splenomegaly (abdominal discomfort, sense of fullness and limitation of mobility due to spleen size). The patient refused splenectomy and, in December 2017, was referred to palliative splenic radiotherapy. He was initially treated with five fractions of one Grey (Gy) in order to evaluate clinical and haematology response. After that, 1.5 Gy daily, 5 days a week for 3 weeks. 3D conformal radiotherapy, multiple fields and mixed energy (6 and 15 Mv) were used.ResultsRadiotherapy allowed significant splenic reduction to almost half the size, resolving abdominal discomfort and improving quality of life. There was no decline of haemoglobin, leukocytes and platelet counts; in fact, there was a marginal increase.ConclusionPalliative splenic irradiation was well tolerated confirming that it is a safe treatment option for palliation of symptomatic splenomegaly. Thereby, splenic irradiation should be strongly considered in the management of symptomatic splenomegaly, for selected patients who are refractory to or unsuitable for other options or when the patient refuses other treatments.

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Section: Discussionmentioning

confidence: 99%

Palliative splenic irradiation for symptomatic splenomegaly in non-Hodgkin lymphoma

Oliveira¹,

Fardilha²,

Louro³

et al. 2018

ecancer

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“…In patients with autoimmune hemolytic anemia not responding to or difficult to control with corticosteroids plus cytotoxic agents, high-dose immunoglobulin or cyclosporine may be tried. A proportion of these patients, however, eventually require splenectomy or low-dose spleen radiation [84]. Pure red-cell aplasia (PRCA) may occasionally be associated with CLL; good treatment results have been reported with cyclosporine [85].…”

Section: Patients With Cytopenias Due To Immune Mechanismmentioning

confidence: 99%

B-cell chronic lymphocytic leukemia: Recent progress in biology, diagnosis, and therapy

Montserrat¹,

Bosch²,

Rozmán³

1997

Annals of Oncology

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SummaryB-cell chronic lymphocytic leukemia (CLL) is a highly common form of leukemia characterized by the accumulation of longlived, functionally inactive, mature appearing neoplastic B lymphocytes. In addition, immune disturbances such as hypogammaglobulinemia and autoimmune phenomena (particularly, autoimmune hemolytic anemia) are frequently found in CLL patients [1][2]. The etiology of CLL is unknown. In contrast with other leukemias, there is no relationship between CLL and exposure to radiation or other cytotoxic agents. A genetic basis is highly likely since there are differences in the incidence of CLL in different countries (e.g., CLL accounts for 30%-40% of all the leukemias in Western countries as compared to 5%-10% in Asian countries) and the risk of contracting CLL is higher among persons with first-degree relatives with the disease [3].Because the incidence of CLL increases with age and the longer life expectancy of the general population, the age of patients at diagnosis is increasing. The median age at diagnosis is now about 70 years, with only one-third of the patients being less than 60 years of age. In the majority of the series, males predominate over females in a proportion of 1.5/1. The prognosis of patients with CLL is variable. However, clinical stages and other prognostic factors allow the individual risk of each patient to be assessed very accurately, which is useful for making treatment decisions.In the past two decades, significant progress has been made in CLL [4][5][6][7][8][9][10]. This review summarizes recent advances in the biology, diagnosis, and therapy of CLL.

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“…Symptomatic lymphadenopathy in CLL stage A(I-II) and B. and SLL stage I-II has an excellent response rate to low-dose radiation, while in some pa tients even an abscopal effect (response in remote un treated tumor) with localized splenic or nodal radiation has been reported [52,53].…”

Section: Treatmentmentioning

confidence: 99%

The Low-Grade Lymphoproliferative Disorders

Eek¹,

Falkson²

1997

Oncology

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Spleen irradiation in chronic lymphocytic leukemia (CLL): Palliation in patients unfit for splenectomy

Cited by 24 publications

References 5 publications

Palliative splenic irradiation for symptomatic splenomegaly in non-Hodgkin lymphoma

Palliative splenic irradiation for symptomatic splenomegaly in non-Hodgkin lymphoma

B-cell chronic lymphocytic leukemia: Recent progress in biology, diagnosis, and therapy

The Low-Grade Lymphoproliferative Disorders

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