Splenectomy in agnogenic myeloid metaplasia and postpolycythemic myeloid metaplasia. A study of 34 cases
B. Brenner, A. Nagler, I. Tatarsky and M. Hashmonai
Department of Hematology, Rambam Medical Center, Haifa, Israel.
A retrospective analysis of 34 successive splenectomies in 137 patients
with myelofibrosis was carried out. Indications, complications, and
response to splenectomy were compared between 22 patients with agnogenic
myeloid metaplasia (AMM) and 12 patients with postpolycythemic myeloid
metaplasia (PPMM). Painful splenomegaly, refractory hemolytic anemia, and
refractory thrombocytopenia were the common indications for surgery. The
best results were obtained for painful splenomegaly. For the other
indications, half to three fourths of the patients improved with
splenectomy. An increased incidence of excessive hemorrhage, infected
hematoma, and early mortality was more common in the PPMM group and was
found to be connected with large spleens, prolonged bleeding time, and
prominent thrombocytopenia. Persistent thrombocytosis after surgery was
more common in the AMM group. Leukemic transformation seemed to be related
to thrombocytosis and to prior therapy with alkylating agents. Median
survival following splenectomy was 43 months in the AMM group and 32 months
in the PPMM group. We conclude that splenectomy has a role in improving the
quality of life by ameliorating mechanical discomfort and decreasing
transfusion requirement in the late phase of AMM. However, in patients with
PPMM, because of the high complication rate, splenectomy should be
carefully considered for specific indications on an individual basis.
