Splenectomy in Advanced Chronic Lymphocytic Leukaemia

Abstract

A group of 20 patients with stage C chronic lymphocytic leukaemia (CLL) and marked splenomegaly refractory to anti-leukaemia treatment was evaluated in relation to clinical course and survival after splenectomy, and compared with a control group of non-splenectomised CLL patients at the same disease stage. Patients in the former group showed a significant clinical improvement after splenectomy, being reallocated to, and maintained in, stages A (85%) or B (10%) for more than 24 months. Ten patients were still alive 24–135 months after splenectomy. The 10 deaths observed in the group of splenectomised patients occurred 4–69 months after surgery, due to disease progression and/or immunoblastic transformation (4 cases), infectious complications (3 cases) and unrelated causes (3 cases). Analysis of survival from diagnosis showed a significantly better prognosis for patients in the splenectomised group (median survival 10 years, as compared to 3.5 years for the control group). The same statistical difference, p < 0.001, with better life expectancy for splenectomised patients, was observed when the survival was calculated from the time of progression to stage C. These results strongly suggest a beneficial role for splenectomy in advanced CLL with significant splenomegaly, when the accumulation of resistant lymphoid cells precludes an adequate control of the disease by conventional forms of treatment.

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.…”

“…Prolonged, disease‐free survivals after splenectomy have been reported in splenic lymphoma with villous lymphocytes and in hairy cell leukaemia (Mulligan et al , 1991; Matutes & Catovsky, 2000). 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).…”

Chronic leukaemias: can they be cured? Part II: chronic lymphocytic leukaemia

“…Splenic irradiation has also been used and may confer marginally better benefit than chemotherapy in patients with advanced B‐CLL 21 . Splenectomy may also be indicated in such patients with advanced disease to reduce transfusion requirements, and until fairly recently used to be the treatment of choice for B‐HCL 22 , 23 .…”