Treatment of Patients with Myelosclerosis

Splenectomy in Acquired Generalized Myelosclerosis

“…Donhauser (1908) was the first to regard the myeloid metaplasia as a compensatory extramedullary haemopoiesis and the spleen as the most important source of red cells, granulocytes, and platelets. If this is a correct hypothesis, splenectomy would be clearly contraindicated (Scott, 1949;Wintrobe, 1951;Learmonth, 1951;Chatterjea, Meza Arrau, and Dameshek, 1952;Hickling, 1953). An alternative hypothesis supported by Vaughan and Harrison (1939), Dameshek (1951), Hutt, Pinniger, and Wetherley-Mein (1953), and Richardson and Pinniger (1953) regards the myelosclerosis and the myeloid metaplasia as part of a proliferative disorder of mesenchymal tissue, in response to an as yet unknown stimulus.…”

“…The removal of a grossly enlarged spleen carries with it the risk of uncontTollable reactionary haemorrhage and is therefore rarely justified for the relief of abdominal symptoms. The treatment of choice in these patients is probably irradiation of the spleen, as recommended by Hickling (1953). If pancytopenia, neutropenia, thrombocytopenia, or haemolytic anaemia develops, then splenectomy is indicated as a possible life-saving measure.…”