Splenectomy in patients with chronic myelomonocytic leukemia: Indications, histopathological findings and clinical outcomes in a single institutional series of thirty-nine patients

Prateek Pophali, Pedro Horna, Terra L. Lasho, Christy M. Finke, Rhett P. Ketterling, Naseema Gangat, David Nagorney, Ayalew Tefferi, Mrinal M Patnaik

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Abstract

In a 28-year period, 39 (7%) patients with chronic myelomonocytic leukemia (CMML) (median age 66 years, 64% male) underwent a splenectomy at our institution. Primary indications for splenectomy were refractory thrombocytopenia (36%), progressive spleen related symptoms (33%), emergent splenectomy for splenic rupture (21%), refractory anemia (8%), and prior to allogeneic stem cell transplant (3%). Eleven (28%) patients had anemia at the time of splenectomy, of which 3 (27%) were autoimmune. The median time to splenectomy from CMML diagnosis was 6 months (0-40); perioperative morbidity and mortality rates were 43% and 13%, while the median postsplenectomy survival was 25 months (11-38). Durable remission in spleen related symptoms, thrombocytopenia, complications from splenic rupture, and anemia were achieved in 85%, 50%, 62%, and 21% of patients, respectively. Perioperative morbidity (n = 30) included infections/sepsis in 6 (20%), intraabdominal bleeding in 4 (13%), venous thromboembolism (VTE) in 3 (10%), and acute lung injury in 2 (7%) patients. The median duration of hospital stay was 6 days (1-25), with 5 deaths occurring secondary to respiratory failure (n = 2), multiorgan dysfunction (n = 2) and hemorrhagic shock (n = 1). There was no difference in overall survival between CMML patients that underwent splenectomy, in comparison to those that did not. Unlike in myelofibrosis, portal hypertension was not an indication for splenectomy and no patients developed post-splenectomy thrombocytosis. In conclusion, apart from being a lifesaving emergent modality in the event of splenic rupture, splenectomy has an important palliative role in patients with CMML, with significant and durable improvements in spleen related symptoms and refractory cytopenias.

Original languageEnglish (US)
Pages (from-to)1347-1357
Number of pages11
JournalAmerican Journal of Hematology
Volume93
Issue number11
DOIs
StatePublished - Nov 1 2018

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Leukemia, Myelomonocytic, Chronic
Splenectomy
Splenic Rupture
Spleen
Thrombocytopenia
Hypersplenism
Refractory Anemia
Morbidity
Thrombocytosis
Primary Myelofibrosis
Survival
Hemorrhagic Shock
Acute Lung Injury
Venous Thromboembolism
Portal Hypertension
Respiratory Insufficiency
Anemia
Length of Stay
Sepsis
Stem Cells

ASJC Scopus subject areas

  • Hematology

Cite this

Splenectomy in patients with chronic myelomonocytic leukemia : Indications, histopathological findings and clinical outcomes in a single institutional series of thirty-nine patients. / Pophali, Prateek; Horna, Pedro; Lasho, Terra L.; Finke, Christy M.; Ketterling, Rhett P.; Gangat, Naseema; Nagorney, David; Tefferi, Ayalew; Patnaik, Mrinal M.

In: American Journal of Hematology, Vol. 93, No. 11, 01.11.2018, p. 1347-1357.

Research output: Contribution to journalArticle

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abstract = "In a 28-year period, 39 (7{\%}) patients with chronic myelomonocytic leukemia (CMML) (median age 66 years, 64{\%} male) underwent a splenectomy at our institution. Primary indications for splenectomy were refractory thrombocytopenia (36{\%}), progressive spleen related symptoms (33{\%}), emergent splenectomy for splenic rupture (21{\%}), refractory anemia (8{\%}), and prior to allogeneic stem cell transplant (3{\%}). Eleven (28{\%}) patients had anemia at the time of splenectomy, of which 3 (27{\%}) were autoimmune. The median time to splenectomy from CMML diagnosis was 6 months (0-40); perioperative morbidity and mortality rates were 43{\%} and 13{\%}, while the median postsplenectomy survival was 25 months (11-38). Durable remission in spleen related symptoms, thrombocytopenia, complications from splenic rupture, and anemia were achieved in 85{\%}, 50{\%}, 62{\%}, and 21{\%} of patients, respectively. Perioperative morbidity (n = 30) included infections/sepsis in 6 (20{\%}), intraabdominal bleeding in 4 (13{\%}), venous thromboembolism (VTE) in 3 (10{\%}), and acute lung injury in 2 (7{\%}) patients. The median duration of hospital stay was 6 days (1-25), with 5 deaths occurring secondary to respiratory failure (n = 2), multiorgan dysfunction (n = 2) and hemorrhagic shock (n = 1). There was no difference in overall survival between CMML patients that underwent splenectomy, in comparison to those that did not. Unlike in myelofibrosis, portal hypertension was not an indication for splenectomy and no patients developed post-splenectomy thrombocytosis. In conclusion, apart from being a lifesaving emergent modality in the event of splenic rupture, splenectomy has an important palliative role in patients with CMML, with significant and durable improvements in spleen related symptoms and refractory cytopenias.",
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AU - Lasho, Terra L.

AU - Finke, Christy M.

AU - Ketterling, Rhett P.

AU - Gangat, Naseema

AU - Nagorney, David

AU - Tefferi, Ayalew

AU - Patnaik, Mrinal M

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AB - In a 28-year period, 39 (7%) patients with chronic myelomonocytic leukemia (CMML) (median age 66 years, 64% male) underwent a splenectomy at our institution. Primary indications for splenectomy were refractory thrombocytopenia (36%), progressive spleen related symptoms (33%), emergent splenectomy for splenic rupture (21%), refractory anemia (8%), and prior to allogeneic stem cell transplant (3%). Eleven (28%) patients had anemia at the time of splenectomy, of which 3 (27%) were autoimmune. The median time to splenectomy from CMML diagnosis was 6 months (0-40); perioperative morbidity and mortality rates were 43% and 13%, while the median postsplenectomy survival was 25 months (11-38). Durable remission in spleen related symptoms, thrombocytopenia, complications from splenic rupture, and anemia were achieved in 85%, 50%, 62%, and 21% of patients, respectively. Perioperative morbidity (n = 30) included infections/sepsis in 6 (20%), intraabdominal bleeding in 4 (13%), venous thromboembolism (VTE) in 3 (10%), and acute lung injury in 2 (7%) patients. The median duration of hospital stay was 6 days (1-25), with 5 deaths occurring secondary to respiratory failure (n = 2), multiorgan dysfunction (n = 2) and hemorrhagic shock (n = 1). There was no difference in overall survival between CMML patients that underwent splenectomy, in comparison to those that did not. Unlike in myelofibrosis, portal hypertension was not an indication for splenectomy and no patients developed post-splenectomy thrombocytosis. In conclusion, apart from being a lifesaving emergent modality in the event of splenic rupture, splenectomy has an important palliative role in patients with CMML, with significant and durable improvements in spleen related symptoms and refractory cytopenias.

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