Salvage Splenectomy In

In patients with pancytopenia due to relapsed or refractory HCL with hypersplenism, splenectomy provides an excellent palliative benefit. Throm-bocytopenia has been reported to improve in up to 92% of patients.13 Early nonrandomized studies suggested a survival benefit, particularly in young symptomatic patients with large spleens and pancy-topenia.41415 Nevertheless, it is currently accepted that splenectomy does not affect long-term survival.16 Splenectomy can be accomplished safely in most patients by laparoscopy,1718 which minimizes recovery time. Patients without significant anemia and with a spleen tip less than 4 cm below the left costal margin are unlikely to respond well to splenectomy.19 Although splenectomy often results in increased hairy cell infiltration into the bone marrow, blood, and abdominal lymph nodes,20 some HCL patients can benefit early after splenectomy with a systemic reduction in malignant cells; complete pathologic remissions in the blood and marrow are rare. Patients with end-stage refractory HCL with transfusion dependence should not be denied splenectomy, as the procedure may be lifesaving in such patients. Nevertheless, splenectomy may be delayed for most relapsed or refractory patients wishing to try a variety of other salvage therapies.

0 0

Post a comment