Contributions
Abstract: PB1777
Type: Publication Only
Background
Chronic lymphocytic leukemia (CLL) is often accompanied by splenomegaly. In certain cases the spleen may enlarge to a giant size, causing abdominal discomfort, regional portal hypertension, and becomes a place of malignant cells concentration. In 2.3-4.3% of cases CLL may be complicated by autoimmune cytopenias (autoimmune hemolytic anemia (AIHA), immune thrombocytopenia (ITP), Evans-Fisher syndrome). Accordingly, the effectiveness of steroid and chemotherapy in such cases may be impaired, raising the question of splenectomy advisability.
Aims
To analyze splenectomy effectiveness in patients with CLL.
Methods
Splenectomy was performed in 41 patients with CLL, 12 of which were patients with CLL and ITP, 9 with CLL and warm type AIHA, 5 patients with CLL and Evans-Fisher syndrome, along with 15 CLL patients without immune disorders. Among the patients there were 26 males and 15 females. Indications to splenectomy were following: massive splenomegaly with abdominal discomfort, immune cytopenia and regional portal hypertension. In one female patient the surgical intervention was performed urgently due to spontaneous splenic rupture and acute intra-abdominal bleeding.
Results
Splenectomy was effective in 37 patients (90.2%): abdominal discomfort disappeared, hemolysis stopped and hemoglobin levels normalized or increased, platelets numbers normalized or increased. Splenectomy was ineffective in 3 patients with CLL associated with ITP: amid elimination of abdominal discomfort the platelets number did not increase significantly (2 patients), while in 1 patient despite increase in platelets number leukemia progression was observed. One (2.4%) patient with CLL and AIHA died on 3rd day after surgery because of acute adrenal insufficiency. The analysis of late effects of splenectomy in patients with CLL showed that average life expectancy after the surgery comprised 111.6 months within observation period between 11 and 277 months. In patients with CLL with immune cytopenias the average life expectancy after surgery was shorter and equal to 60.7 months within the observation period between 2 and 361 months.
Conclusion
Splenectomy remains an effective method of treatment of patients with CLL accompanied by severe splenomegaly and immune cytopenia. Long-term results of splenectomy in patients with CLL without cytopenia are better than in patients with CLL and cytopenias. Aggressive hemolysis, large spleen covered in perisplenic adhesions, amid portal hypertension and thrombocytopenia are considered to be special surgical risk factors in this patients.
Session topic: 6. Chronic lymphocytic leukemia and related disorders - Clinical
Keyword(s): Splenectomy, Chronic Lymphocytic Leukemia
Abstract: PB1777
Type: Publication Only
Background
Chronic lymphocytic leukemia (CLL) is often accompanied by splenomegaly. In certain cases the spleen may enlarge to a giant size, causing abdominal discomfort, regional portal hypertension, and becomes a place of malignant cells concentration. In 2.3-4.3% of cases CLL may be complicated by autoimmune cytopenias (autoimmune hemolytic anemia (AIHA), immune thrombocytopenia (ITP), Evans-Fisher syndrome). Accordingly, the effectiveness of steroid and chemotherapy in such cases may be impaired, raising the question of splenectomy advisability.
Aims
To analyze splenectomy effectiveness in patients with CLL.
Methods
Splenectomy was performed in 41 patients with CLL, 12 of which were patients with CLL and ITP, 9 with CLL and warm type AIHA, 5 patients with CLL and Evans-Fisher syndrome, along with 15 CLL patients without immune disorders. Among the patients there were 26 males and 15 females. Indications to splenectomy were following: massive splenomegaly with abdominal discomfort, immune cytopenia and regional portal hypertension. In one female patient the surgical intervention was performed urgently due to spontaneous splenic rupture and acute intra-abdominal bleeding.
Results
Splenectomy was effective in 37 patients (90.2%): abdominal discomfort disappeared, hemolysis stopped and hemoglobin levels normalized or increased, platelets numbers normalized or increased. Splenectomy was ineffective in 3 patients with CLL associated with ITP: amid elimination of abdominal discomfort the platelets number did not increase significantly (2 patients), while in 1 patient despite increase in platelets number leukemia progression was observed. One (2.4%) patient with CLL and AIHA died on 3rd day after surgery because of acute adrenal insufficiency. The analysis of late effects of splenectomy in patients with CLL showed that average life expectancy after the surgery comprised 111.6 months within observation period between 11 and 277 months. In patients with CLL with immune cytopenias the average life expectancy after surgery was shorter and equal to 60.7 months within the observation period between 2 and 361 months.
Conclusion
Splenectomy remains an effective method of treatment of patients with CLL accompanied by severe splenomegaly and immune cytopenia. Long-term results of splenectomy in patients with CLL without cytopenia are better than in patients with CLL and cytopenias. Aggressive hemolysis, large spleen covered in perisplenic adhesions, amid portal hypertension and thrombocytopenia are considered to be special surgical risk factors in this patients.
Session topic: 6. Chronic lymphocytic leukemia and related disorders - Clinical
Keyword(s): Splenectomy, Chronic Lymphocytic Leukemia