SPLENECTOMY AS AN ADJUVANT MEASURE IN THE TREATMENT OF SEVERE APLASTIC-ANEMIA

The role of splenectomy in aplastic anaemia (AA) is controversial, The hazards of operating on a severely pancytopenic patient, the fear of compromising the patient's immune function, and the improvement of non -surgical treatment have made splenectomy unpopular in this disease. W e have evaluated positive and adverse effects of splenectomy in 80 pat ients with severe aplastic anaemia (SAA) treated with antilymphocyte g lobulin (ALG) (group A), using 52 nonsplenectomized ALG patients as co ntrols (group B). All patients survived the operation. Nonfatal compli cations of surgery occurred in 10 (12.5%). Splenectomy induced a signi ficant increase of peripheral blood neutrophils, reticulocytes and pla telets within 2 weeks, followed by a continuous increase of all values over the following weeks. 28/132 patients (21%) developed a late clon al disorder of haemopoiesis, paroxysmal nocturnal haemoglobinuria (PNH ) or myelodysplastic syndrome (MDS), or both. Their incidence was iden tical in groups A and B. 13/28 (59%) died, 10/17 (59%) in group A and 3/11 (27%) in group B (not significant (n.s.)). Overall probability of survival at 18 years after ALG was 51 +/- 6% for group A and 61 +/- 7 % for group B (n.s.). We conclude that splenectomy in AA is safe. It i nduces an immediate increase of peripheral blood counts and, thereafte r, a continuous improvement of haemopoiesis. It does not increase the incidence of late clonal complications but has a borderline effect on mortality from these disorders. Splenectomy should be reconsidered in selective nontransplanted patients who have prolonged transfusion requ irements despite otherwise optimal treatment.