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

Abstract

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.

Diagnostic and therapeutic splenectomy for splenic lymphomas: analysis of the National Cancer Data Base

“…Rare subtypes like the splenic diffuse red pulp B-cell lymphoma may still require splenectomy for unequivocal diagnosis [8]. The fact that many splenic lymphomas involve the blood and bone marrow, and that they can be effectively treated with immunochemotherapy has further decreased the need for therapeutic splenectomy [9][10][11][12].…”

Extranodal and splenic small B-cell lymphoma

“…59 Mantle cell lymphoma presenting with massive splenomegaly and a leukaemic phase shows typical morphology but may be associated with a more indolent course with initial response to splenectomy alone and delayed requirement for chemotherapy. 60 A variant of mantle cell lymphoma where the cells are larger and the nuclei are round with small central eosinophilic nucleoli has been described which does not correspond to either of the conventionally recognised blastoid or pleomorphic variants. This nucleolated variant may be confused with B-prolymphocytic leukaemia but the cells stain for cyclin D1 and show the characteristic t (11;14) translocation.…”

How I diagnose and treat splenic lymphomas

“…63 Splenectomy has demonstrated impressive and durable responses in splenic MCLs, producing a significant reduction of the circulating leukemic component along with an effective recovery from cytopenia. 64 Whether this seemingly indolent clinical behavior observed after …”