SPLENECTOMY IN THE ACCELERATED OR BLASTIC PHASE OF CHRONIC MYELOGENOUS LEUKEMIA - A SINGLE-INSTITUTION, 25-YEAR EXPERIENCE

Background. Patients in the accelerated or blastic phases of chronic m yelogenous leukemia (CML) often have painful splenomegaly and secondar y thrombocytopenia. We tested the hypothesis that splenectomy can be p erformed with minimal complications in advanced CML, thereby alleviati ng pain, reversing thrombocytopenia, and minimizing transfusion requir ements. Methods. We reviewed the records of 53 patients in the acceler ated or blastic phases of CML who underwent splenectomy between 1970 a nd 1995 at the U. T. M. D. Anderson Cancer Center. Results. Twenty-eig ht patients were in accelerated phase and 25 in blastic phase at the t ime of splenectomy. The most common indications for splenectomy were s ymptomatic splenomegaly (median splenic weight, 1000 gm; range, 120 to 6700 gm) or thrombocytopenia (platelet count less than 100,000/mu l) or both. There was 1 death within 30 days of splenectomy. The preopera tive platelet count increased 3.72-fold +/- 0.53-fold (mean +/- SEM) b y postoperative day 7 (p < 0.001; paired t test). Patients with transf usion-dependent thrombocytopenia had significantly fewer platelet and red blood cell transfusion in the 6 months after splenectomy than in t he 6 months before splenectomy (p = 0.016; sign test). Conclusions. Sp lenectomy can be performed with minimal morbidity and mortality in adv anced CML, thereby relieving symptomatic splenomegaly, reversing throm bocytopenia, and minimizing transfusion requirements.