Therapeutic splenectomy in MMM may result in extreme thrombocytosis, leukocytosis, and accelerated hepatomegaly.81 Palliative benefit from the purine nucleoside analog 2-chlorodeoxyadenosine (2-CdA) has been reported to provide beneficial cytoreduction in such instances.81 The agent has been used successfull in MMM in either of two common schedules (0.10 mg/kg intravenously by continuous infusion for 7 days or 5 mg/m2 intravenously over 2 h for five consecutive days per cycle). 2-CdA (after a median of one to two cycles) responses were observed in 55, 50, 55, and 40% of patients for hepatomegaly, thrombocytosis, leuko-cytosis, and anemia, respectively. Cytopenias were frequent, but usually transient and without clinical consequence. Responses were sustained for a median of 6 months after discontinuation of the treatment.

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