Nr

CR: complete response; PR: partial response; NR: not reported.

CR: complete response; PR: partial response; NR: not reported.

Despite a concern about an increased incidence of infections following splenectomy, Golomb found no change in infectious complications in postsplenec-tomy patients.34 43 Nevertheless, vaccinations against encapsulated organisms are recommended prior to splenectomy.

With the advent of new, more effective treatment modalities, splenectomy has fallen out of favor. It is now considered a temporizing measure, with a median time to treatment failure of 8.3 months (range, 1-22 months). Even prior to the adoption of modern surgical techniques, including laparoscopic splenectomy, surgical mortality was low, estimated at 2% in some reports.41 Splenectomy has been safely performed at the twenty-fourth week of gestation in a pregnant patient with hairy cell leukemia.44

Current indications for splenectomy as an initial treatment approach to hairy cell leukemia include active or uncontrolled infections in the setting of severe and refractory neutropenia secondary to hairy cell leukemia, thrombocytopenic bleeding, massive, painful, or ruptured splenomegaly, or contraindications to chemotherapy (e.g., pregnancy or medical comorbidities).

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