OPEN FORUM Pros and Cons of Splenectomy in Patients
Leukemia (2001) 15, 465–467 2001 Nature Publishing Group All rights reserved 0887-6924/01 $15.00 www.nature.com/leu OPEN FORUM Pros and cons of splenectomy in patients with myelofibrosis undergoing stem cell transplantation Z Li and HJ Deeg Fred Hutchinson Cancer Research Center and the University of Washington, Seattle, WA, USA During fetal development, the spleen is a major hemopoietic the possible immunological consequences of splenectomy, organ. In the adult human, this task is relinquished to the bone and discuss factors that may influence the decision on marrow. However, under the stress of certain pathologic con- ditions, extramedullary hemopoiesis may again occur in the splenectomy in the management of myelofibrosis. spleen. This is especially true for diseases of the marrow, in particular, myeloproliferative disorders such as agnogenic myeloid metaplasia, which is associated with severe fibrosis of Clinical controversies the marrow space. At the same time, the spleen sequesters blood cells and contributes to peripheral blood cytopenias, Surgical splenectomy and splenic irradiation have been part which may improve following splenectomy. However, success is unpredictable, and the operative mortality of splenectomy is of the management of AMM for two reasons: firstly, to relieve on the order of 10%. As a growing number of patients undergo symptoms associated with splenomegaly, and secondly, to hemopoietic stem cell transplantation as definitive therapy for possibly slow disease progression, although this notion is not myelofibrosis, the decision on splenectomy has additional well supported by data. In fact, some reports suggest that in ramifications since the spleen plays an important role in the patients with AMM, splenectomy is associated with an kinetics of engraftment of donor cells and in immune reconsti- increased risk of blast transformation.4 Tefferi and colleagues2 tution.
[Show full text]