TY - JOUR
T1 - Splenectomy in patients with myeloproliferative neoplasms
T2 - Efficacy, complications and impact on survival and transformation
AU - Santos, Fabio P.S.
AU - Tam, Constantine S.
AU - Kantarjian, Hagop
AU - Cortes, Jorge
AU - Thomas, Deborah
AU - Pollock, Raphael
AU - Verstovsek, Srdan
N1 - Funding Information:
This research was supported in part by M. D. Anderson Cancer Center Support Grant CA016672.
PY - 2014/1
Y1 - 2014/1
N2 - Splenectomy may be an effective therapeutic option for treating massive splenomegaly in patients with myeloproliferative neoplasms (MPNs). There are still limited data on its short- and long-term benefits and risks. Efficacy and short-term complications were analyzed in 94 patients with different MPNs who underwent splenectomy at M. D. Anderson Cancer Center. The long-term impact of splenectomy on overall survival (OS) and transformation free survival (TFS) was evaluated in 461 patients with myelofibrosis (MF) seen at M. D. Anderson, including 50 who underwent splenectomy during disease evolution. Splenectomy improved anemia and thrombocytopenia in 47% and 66% of patients, respectively. The most common complications were leukocytosis (76%), thrombocytosis (43%) and venous thromboembolism (16%). Post-operative mortality was 5%. Among patients with MF, splenectomy during disease evolution was associated with decreased OS (hazard ratio [HR] = 2.17, p < 0.0001) and TFS (HR = 2.17, p < 0.0001). This effect was independent of the Dynamic International Prognostic Scoring System. Splenectomy is a possible therapeutic option for patients with MF and other MPNs, and its greatest benefits are related to improvement in spleen pain and discomfort, anemia and thrombocytopenia. However, in patients with MF it appears to be associated with increased mortality.
AB - Splenectomy may be an effective therapeutic option for treating massive splenomegaly in patients with myeloproliferative neoplasms (MPNs). There are still limited data on its short- and long-term benefits and risks. Efficacy and short-term complications were analyzed in 94 patients with different MPNs who underwent splenectomy at M. D. Anderson Cancer Center. The long-term impact of splenectomy on overall survival (OS) and transformation free survival (TFS) was evaluated in 461 patients with myelofibrosis (MF) seen at M. D. Anderson, including 50 who underwent splenectomy during disease evolution. Splenectomy improved anemia and thrombocytopenia in 47% and 66% of patients, respectively. The most common complications were leukocytosis (76%), thrombocytosis (43%) and venous thromboembolism (16%). Post-operative mortality was 5%. Among patients with MF, splenectomy during disease evolution was associated with decreased OS (hazard ratio [HR] = 2.17, p < 0.0001) and TFS (HR = 2.17, p < 0.0001). This effect was independent of the Dynamic International Prognostic Scoring System. Splenectomy is a possible therapeutic option for patients with MF and other MPNs, and its greatest benefits are related to improvement in spleen pain and discomfort, anemia and thrombocytopenia. However, in patients with MF it appears to be associated with increased mortality.
KW - Acute myeloid leukemia
KW - Myelofibrosis
KW - Myeloproliferative neoplasms
KW - Splenectomy
KW - Survival
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U2 - 10.3109/10428194.2013.794269
DO - 10.3109/10428194.2013.794269
M3 - Article
C2 - 23573823
AN - SCOPUS:84891360270
SN - 1042-8194
VL - 55
SP - 121
EP - 127
JO - Leukemia and Lymphoma
JF - Leukemia and Lymphoma
IS - 1
ER -