Indications for splenectomy in the B-cell lymphoid neoplasia and its results

Keywords: chronic lymphocytic leukemia; lymphoma of splenic marginal zone; hairy-cell leukemia; splenectomy

Abstract

Objective. To summarize the indications for splenectomy in the patients, suffering  B-lymphoproliferative neoplasia and to estimate its efficacy.

Materials and methods. Splenectomy was performed in 41 patients, suffering chronic lymphocytic leukemia (CHLL), in 46 patients, suffering lymphoma of the splenic marginal zone (LSMZ), in 27 patients with hairy-cell leukemia (HCL).

Results. Splenectomy while diagnostic problems present gives possibility to verify a variant of lymphoid neoplasia. Operation permits to eliminate the tumor of large volume, the abdominal compression, hemolysis, the thrombocytes quantity normalization, lowering or disappearance of need for cytostatic therapy. Immediate positive result was achieved in 92.7% patients, suffering CHLL, in 95.7% patients with LSMZ, in 81% patients with HCL.

Conclusion. Splenectomy in lymphoid neoplasia is performed in accordance to diagnostic and/or the treatment indications. Splenectomy with the treatment objective is indicated in presence of massive splenomegaly, resistant to cytostatic therapy with signs of abdominal compression, hemocytopenia of the immune or hypersplenic character, regional portal hypertension.

Author Biographies

Yu. L. Evstakhevych, Institute of The Blood Pathology and Transfusional Medicine, Lviv

Yevstakhevych, Yuriy Lvovych - MD, PhD, Leading Scientific Researcher,
Department and Clinic of Common and Hematological Surgery,
Institute of Blood Pathology and Transfusion Medicine;
45, Chuprynky str., L’viv, 79044, Ukraine,
tel. +38 032 2383247;
E-mail: yevstakhevychyl@gmail.com
http://orcid.org/0000-0002-7752-9477

I. J. Evstakhevych, Institute of The Blood Pathology and Transfusional Medicine, Lviv

Yevstakhevych, Ihor Yosyfovych - MD, PhD, DMedSci, Head,
Department and Clinic of Common and Hematological Surgery,
Institute of Blood Pathology and Transfusion Medicine;
45, Chuprynky str., L’viv, 79044, Ukraine,
tel. +38 032 2383247;
E-mail: i.yevstakhevych@ukr.net
http://orcid.org/0000-0001-7215-7515

O. Ya. Vyhovska, Institute of The Blood Pathology and Transfusional Medicine, Lviv

Vyhovska, Olha Yaroslavivna - MD, Hematologist,
Clinic of Hematology,
Institute of Blood Pathology and Transfusion Medicine,
45, Chuprynky str., L’viv, 79044, Ukraine,
tel. +38 032 2383247;
E-mail: olichkavygovska@gmail.com
http://orcid.org/0000-0002-5164-7969

M. M. Semerak, Institute of The Blood Pathology and Transfusional Medicine, Lviv

Semerak, Maksym Mykhajlovych - MD, Scientific Researcher,
Department and Clinic of Common and Hematological Surgery,
Institute of Blood Pathology and Transfusion Medicine,
45, Chuprynky str., L’viv, 79044, Ukraine,
tel. +38 032 2383247;
E-mail: msemerak@ukr.net
http://orcid.org/0000-0001-7394-2590

V. E. Loginsky, Institute of The Blood Pathology and Transfusional Medicine, Lviv

Loginsky Volodymyr Eustakhovych - MD, PhD, DMedSci, Prof,
Scientific Vice-Director,
Institute of Blood Pathology and Transfusion Medicine,
45, Chuprynky str., L’viv, 79044, Ukraine,
tel. +38 032 2383247;
E-mail: vol.lohinsky@hotmail.com
http://orcid.org/0000-0003-1904-9827

References

Iannitto E, Tripodo C. How I diagnose and treat splenic lymphomas. Blood. 2011; 117(9):2585-95. doi: 10.1182/blood-2010-09-271437.

Jones G, Parry-Jones N, Wilkins B, Else M, Catovsky D. Revised guidelines for the diagnosis and management of hairy cell leukaemia and hairy cell leukaemia variant. Br J Haematol. 2012; 156(2):186-95. doi: 10.1111/j.1365-2141.2011.08931.

Ruchlemer R, Wotherspoon AC, Thompson JN, Swansbury JG, Matutes E, Catovsky D. Splenectomy in mantle cell lymphoma with leukaemia: A comparison with chronic lymphocytic leukaemia. Br J Haematol. 2002; 118(4):952-8. doi.org/10.1046/j.1365-2141.2003.04165.x

Hill QA, Stamps R, Massey E, Grainger JD, Provan D, Hill A. Guidelines on the management of drug-induced immune and secondary autoimmune, haemolytic anaemia. Br J Haematol. 2017; 177(2):208-220. doi: 10.1111/bjh.14654.

Lechner K, Jager U. How I treat autoimmune hemolytic anemias in adults. Blood. 2010;116(11):1831-8. doi: 10.1182/blood-2010-03-259325.

Browning MG, Bullen N, Nokes T, Tucker K, Coleman M. The evolving indications for splenectomy. Br J Haematol. 2017; 177(2):319-330. doi:10/1111/bjh.14060.

Smeltzer J, Habermann TM, Timucin T, Nagorney D, Ristow K, Colgan JP, et al. Long term clinical outcomes in patients with massive splenomegaly and non-Hodgkin's lymphoma treated with splenectomy. Blood [Internet]. 2012; 120(21):2692. Available from: http://bloodjournal.org/content/120/21/2692.

Clavien PA, Barkun, J, de Oliveira ML, Vauthey JN, Dindo D, Schulick D, et al. The Clavien-Dindo classification of surgical complications: five-year experience. Ann Surg. 2009; 250(2):187-96. doi: 10.1097/SLA.0b013e3181b13ca2.

Barmparas G, Lamb AW, Lee D, Nguyen B, Eng J, Bloom MB, et al. Postoperative infection risk after splenectomy: a prospective cohort study. Int J Surg. 2015;17:10-4. doi: 10.1016/j.ijsu.2015.03.007.

Davidson RN, Wall RA. Prevention and management of infections in patients without a spleen. Clin Microbiol Infect. 2001; 7(12):657-60. doi.org/10.1046/j.1198-743.

Else M, Marín-Niebla A, de la Cruz F, Batty P, Ríos E, Dearden CE, et al. Rituximab, used alone or in combination, is superior to other treatment modalities in splenic marginal zone lymphoma. Br J Haematol. 2012;159(3):322-8. doi: 10.1111/bjh.12036.

Lenglet J, Traulle C, Mounier N, Benet C, Munoz-Bongrand N, Amorin S, et al. Long-term follow-up analysis of 100 patients with splenic marginal zone lymphoma treated with splenectomy as first line treatment. Leuk Lymphoma. 2014; 55(8):1854-60. doi: 10.3109/10428194.2013.861067.

Iannitto E, Tripodo C. Treatment of splenic lymphomas. Haematology Education: the education program for the annual congress of the European Hematology Association [Internet]. 2012;6(1):429-36. Available from: https://library.ehaweb.org/eha/2012/17th/97235/emilio.g.iannitto.treatment.of.splenic.lymphomas.html?f=menu%3D6%2Abrowseby%3D8%2Asortby%3D2%2Amedia%3D6%2Ace_id%3D498%2Aot_id%3D10306.

Sarid N, Ahmad HN, Wotherspoon A, Dearden CE, Else M, Catovsky D. An unusual indication for splenectomy in hairy cell leukaemia: a report of three cases with persistent splenomegaly after chemoimmunotherapy. Br J Haematol. 2015;171(5):784-7. doi:10.1111/bjh.13767.

Published
2019-08-29
How to Cite
Evstakhevych, Y. L., Evstakhevych, I. J., Vyhovska, O. Y., Semerak, M. M., & Loginsky, V. E. (2019). Indications for splenectomy in the B-cell lymphoid neoplasia and its results . Klinicheskaia Khirurgiia, 86(8), 50-54. https://doi.org/10.26779/2522-1396.2019.08.50
Section
General Problems of Surgery