SPLENECTOMY IN LYMPHOPROLIFERATIVE DISORDERS - A REPORT ON 70 CASES AND REVIEW OF THE LITERATURE

Between February, 1970 and September, 1991, we performed splenectomies on 70 patients with chronic lymphoproliferative disorders including p rimary leukemias: 19 B-cell chronic lymphocytic leukemia, 1 B-cell pro lymphocytic leukemia, 22 hairy cell leukemias, 4 large granular lympho cytic leukemias, 1 T-cell prolymphocytic leukemia, and non-Hodgkin's l ymphomas (NHL): 10 splenic lymphomas with villous lymphocytes, 4 folli cular lymphomas, 5 mantle cell lymphomas, 3 lymphoplasmacytic and 1 la rge cell NHL. The primary indications for surgery in this series were therapy-resistant disease (40%) and therapeutic splenectomy (38%). Pos tsplenectomy, 70% of patients had a complete hematological response, 2 3% had a partial response, and 7% were nonresponsive. Median treatment -free survival correlated with the hematologic response postsplenectom y and the underlying diagnosis. Better treatment-free survivals were s een in patients with lesser degrees of anemia and thrombocytopenia. Ov erall, improvements were more pronounced in the B-cell than in the T-c ell disorders. Indications for further therapy, postoperative morbidit y and mortality, and survival times are discussed along with a review of the literature. These findings advocate a continuing role for splen ectomy in symptomatic lymphoid malignancies running with splenomegaly and hypersplenism.