Splenectomy in hairy cell leukemia: A retrospective multicenter analysis

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Abstract
To study the effect of splenectomy in hairy cell leukemia, we initiated a retrospective multicenter analysis. A series of 391 patients, contributed by 22 centers (median: 15 cases per center, range 2–130), was analyzed. Since comparison of the data from these centers showed few significant differences, the data were pooled. Factors that proved to have prognostic value at the time of diagnosis were the hemoglobin level and the neutrophil and platelet counts. Survival after diagnosis was significantly longer in the splenectomy group (n = 225) than in the nonsplenectomy group (n = 166) (P < 0.0001). When subgroups were analyzed, no difference in survival time was found between splenectomized and nonsplenectomized patients having an age >60 years, symptoms >12 months, spleens < 4 cm under costal margin, hemoglobin levels >12 g/dl, neutrophils >500/mm3, or platelets >100,000/mm3. After the operation, the platelet count usually increased to acceptable values, whereas the neutrophil count increased less often. Patients with Hb >11 g/dl, neutrophils >1,000/mm3, and platelets >100,000/mm3after splenectomy, survived longer than patients with a less complete response to the operation (P< 0.01). In patients with definite splenomegaly and pancytopenia, splenectomy seems to be beneficial. However, in patients without distinctly enlarged spleens, other therapeutical modalities should be considered.

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