Splenectomy for hematologic diseases at Fundación Santa Fe de Bogotá : characterization and evaluation of multiple outcomes.
Esplenectomía para patologías hematológicas en la Fundación Santa Fe de Bogotá : caracterización y evaluación de múltiples desenlaces.
Article Sidebar
PDF (Español (España))
FLIP
Esta obra está bajo una licencia internacional Creative Commons Atribución-NoComercial 4.0.
Main Article Content
Introduction: Splenectomy represents a diagnostic and therapeutic strategy for many benign and malignant hematological conditions. The following article presents the results an analyzed series of splenectomized patients due to hematological diseases in Fundación Santa Fé de Bogotá. Materials and methods: Between 2004 and 2011, thirty patients were splenectomized based on hematological benign (n = 23) and malignant (n = 7) disease as indication. Clinical records were evaluated to obtain information on various parameters and long term outcomes. Results: The average age of patients was 54 years old and the sample was mainly composed by women (64%). Before surgery, the principal diagnosis was immune thrombocytopenic purpura (ITP) (60%); 23% required any degree of transfusional support and splenectomy was used as first or second line of treatment in 60% of the cases. Seven cases were excluded: four due to diagnostic splenectomy and three due to loss to follow-up. 23 patients were included for long-term analysis. During the 30-day post-operative period, there were 17.4% infectious and 13% hemorrhagic complications, none of which led to death. A complete hematological response was obtained following splenectomy in 78% of the cases and the overall survival was 133 months (r, 108-157), which was lower in whom had transfusional dependence (p = 0.04), and whom reached any hematologic response (p = 0.026). Long-term adverse events presented in less than 10%. Conclusions: Splenectomy reaches important hematologic responses in benign and malignant blood diseases and results in a high survival rate, with a low frequency of complications. Overall survival is modified mainly by preoperative transfusional dependence; we suggest exploring this variable as a survival predictor in future studies.
Downloads
Article Details
DeFrances CJ, Cullen KA, Kozak LJ. National Hospital Discharge Survey: 2005 annual summary with detailed diagnosis and procedure data. Vital Health Stat. 2007;(165):1-209.
Di Sabatino A, Carsetti R, Corazza GR. Post-splenectomy and hyposplenic states. Lancet. 2011;378(9785):86-97.
Kraus MD, Fleming MD, Vonderheide RH. The spleen as a diagnostic specimen: a review of 10 years’ experience at two tertiary care institutions. Cancer. 2001;91(11):2001-9.
Sutherland GA, Burghard FF. The Treatment of Splenic Anaemia by Splenectomy. Proc R Soc Med. 1911;4(Clin Sect):58-70.
Kaznelson P. Splenogene thrombolytische purpura. Wien Klin Wochn Schr. 1916;29:1451-4.
Miwa S. Pyruvate kinase deficiency. Prog Clin Biol Res. 1990;344:843-52.
Neunert C, Lim W, Crowther M, Cohen A, Solberg L Jr, Crowther MA, et al. The American Society of Hematology 2011 evidencebased practice guideline for immune thrombocytopenia. Blood. 2011;117(16):4190-207.
Lechner K, Jäger U. How I treat autoimmune hemolytic anemias in adults. Blood. 2010;116(11):1831-8.
Schilling RF. Risks and benefits of splenectomy versus no splenectomy for hereditary spherocytosis--a personal view. Br J Haematol. 2009;145(6):728-32.
Taher A, Isma’eel H, Cappellini MD. Thalassemia intermedia: revisited. Blood Cells Mol Dis. 2006;37(1):12-20.
Dameshek W, Rubio F Jr, Mahoney JP, Reeves WH, Burgin LA. Treatment of idiopathic thrombocytopenic purpura (ITP) with prednisone. J Am Med Assoc. 1958;166(15):1805-15.
Stasi R, Provan D. Management of immune thrombocytopenic purpura in adults. Mayo Clin Proc. 2004;79(4):504-22.
Coon WW. Splenectomy in the treatment of hemolytic anemia. Arch Surg. 1985;120(5):625-8.
Necheles TF, Finkel HE, Sheehan RG, Allen DM. Red cell pyruvate kinase deficiency. The effect of splenectomy. Arch Intern Med. 1966;118(1):75-8.
Iannitto E, Ambrosetti A, Ammatuna E, Colosio M, Florena AM, Tripodo C, et al. Splenic marginal zone lymphoma with or without villous lymphocytes. Hematologic findings and outcomes in a series of 57 patients. Cancer. 2004;101(9):2050-7.
Bennett M, Schechter GP. Treatment of splenic marginal zone lymphoma: splenectomy versus rituximab. Semin Hematol. 2010;47(2):143-7.
Berman RS, Yahanda AM, Mansfield PF, Hemmila MR, Sweeney JF, Porter GA, et al. Laparoscopic splenectomy in patients with hematologic malignancies. Am J Surg. 1999;178(6):530-6.
Cavaliere D, Torelli P, Panaro F, Casaccia M, Ghinolfi D, Santori G, et al. Outcome of laparoscopic splenectomy for malignant hematologic diseases. Tumori. 2004;90(2):229-32.
Rosen M, Brody F, Walsh RM, Tarnoff M, Malm J, Ponsky J. Outcome of laparoscopic splenectomy based on hematologic indication. Surg Endosc. 2002;16(2):272-9.
Franklin M, Gálvez-Hernández CA, Treviño J, Villegas-Cabello O, González-Ruvalcaba R, Díaz-Elizondo J. [Laparoscopic splenectomy: Twelve-year experience in two private institutions]. Cir Cir. 2006;74(6):443-7.
Delaitre B, Maignien B. [Splenectomy by the laparascopic approach. Report of a case]. Presse Med. 1991;20(44):2263.
Maluenda GF, P PB, Braghetto MI, Csendes JA. Esplenectomía laparoscópica en enfermedades hematológicas. Rev Med Chile. 2004;132:189-94.
Cheson BD, Pfistner B, Juweid ME, Gascoyne RD, Specht L, Horning SJ, et al. Revised response criteria for malignant lymphoma. J Clin Oncol. 2007;25(5):579-86.
Kojouri K, Vesely SK, Terrell DR, George JN. Splenectomy for adult patients with idiopathic thrombocytopenic purpura: a systematic review to assess long-term platelet count responses, prediction of response, and surgical complications. Blood. 2004;104(9):2623-34.
Schoonen WM, Kucera G, Coalson J, Li L, Rutstein M, Mowat F, et al. Epidemiology of immune thrombocytopenic purpura in the General Practice Research Database. Br J Haematol. 2009;145(2):235-44.
Balagué C, Targarona EM, Cerdán G, Novell J, Montero O, Bendahan G, et al. Long-term outcome after laparoscopic splenectomy related to hematologic diagnosis. Surg Endosc. 2004;18(8):1283-7.
Musser G, Lazar G, Hocking W, Busuttil RW. Splenectomy for hematologic disease. The UCLA experience with 306 patients. Ann Surg. 1984;200(1):40-5.
Ucar K. Clinical presentation and management of hemolytic anemias. Oncology. (Williston Park) 2002;16(9 Suppl 10):163-70.
Habermalz B, Sauerland S, Decker G, Delaitre B, Gigot JF, Leandros E, et al. Laparoscopic splenectomy: the clinical practice guidelines of the European Association for Endoscopic Surgery (EAES). Surg Endosc. 2008;22(4):821-48.
Garratty G. The James Blundell Award Lecture 2007: do we really understand immune red cell destruction? Transfus Med. 2008;18(6):321-34.
Atkinson JP, Schreiber AD, Frank MM. Effects of corticosteroids and splenectomy on the immune clearance and destruction of erythrocytes. J Clin Invest. 1973;52(6):1509-17.
Akpek G, McAneny D, Weintraub L. Comparative response to splenectomy in Coombs-positive autoimmune hemolytic anemia with or without associated disease. Am J Hematol. 1999;61(2):98-102.
Thieblemont C, Felman P, Berger F, Dumontet C, Arnaud P, Hequet O, et al. Treatment of splenic marginal zone B-cell lymphoma: an analysis of 81 patients. Clin Lymphoma. 2002;3(1):41-7.
Troussard X, Valensi F, Duchayne E, Garand R, Felman P, Tulliez M, et al. Splenic lymphoma with villous lymphocytes: clinical presentation, biology and prognostic factors in a series of 100 patients. Groupe Francais d’Hematologie Cellulaire (GFHC). Br J Haematol. 1996;93(3):731-6.
Kalpadakis C, Pangalis GA, Dimopoulou MN, Vassilakopoulos TP, Kyrtsonis MC, Korkolopoulou P, et al. Rituximab monotherapy is highly effective in splenic marginal zone lymphoma. Hematol Oncol. 2007;25(3):127-31.
Arcaini L, Orlandi E, Scotti M, Brusamolino E, Passamonti F, Burcheri S, et al. Combination of rituximab, cyclophosphamide, and vincristine induces complete hematologic remission of splenic marginal zone lymphoma. Clin Lymphoma. 2004;4(4):250-2.
Zimmer J, Andrés E, Noel E, Koumarianou A, Blicklé JF, Maloisel F. Current management of adult idiopathic thrombocytopenic purpura in practice: a cohort study of 201 patients from a single center. Clin Lab Haematol. 2004;26(2):137-42.
Kumar S, Diehn FE, Gertz MA, Tefferi A. Splenectomy for immune thrombocytopenic purpura: long-term results and treatment of postsplenectomy relapses. Ann Hematol. 2002;81(6):312-9.
Kaya E, Erkurt MA, Aydogdu I, Kuku I, Ozhan O, Oner RI, et al. Retrospective analysis of patients with idiopathic thrombocytopenic purpura from Eastern Anatolia. Med Princ Pract. 2007;16(2):100-6.
Schwartz J, Leber MD, Gillis S, Giunta A, Eldor A, Bussel JB. Long term follow-up after splenectomy performed for immune thrombocytopenic purpura (ITP). Am J Hematol. 2003;72(2):94-8.
Wang T, Xu M, Ji L, Han ZC, Yang R. Splenectomy for adult chronic idiopathic thrombocytopenic purpura: experience from a single center in China. Eur J Haematol. 2005;75(5):424-9.
Pamuk GE, Pamuk ON, Baslar Z, Ongören S, Soysal T, Ferhanoglu B, et al. Overview of 321 patients with idiopathic thrombocytopenic purpura. Retrospective analysis of the clinical features and response to therapy. Ann Hematol. 2002;81(8):436-40.
Gordon-Smith EC. Erythrocyte enzyme deficiencies. Pyruvate kinase deficiency. J Clin Pathol Suppl. (R Coll Pathol) 1974;8:128-33.
Tanaka KR, Paglia DE. Pyruvate kinase deficiency. Semin Hematol. 1971;8(4):367-96.
Dierickx D, Verhoef G, Van Hoof A, Mineur P, Roest A, Triffet A, et al. Rituximab in auto-immune haemolytic anaemia and immune thrombocytopenic purpura: a Belgian retrospective multicentric study. J Intern Med. 2009;266(5):484-91.
Mulligan SP, Matutes E, Dearden C, Catovsky D. Splenic lymphoma with villous lymphocytes: natural history and response to therapy in 50 cases. Br J Haematol. 1991;78(2):206-9.
Tsimberidou AM, Catovsky D, Schlette E, O’Brien S, Wierda WG, Kantarjian H, et al. Outcomes in patients with splenic marginal zone lymphoma and marginal zone lymphoma treated with rituximab with or without chemotherapy or chemotherapy alone. Cancer. 2006;107(1):125-35.
Chanan-Khan AA, Giralt S. Importance of achieving a complete response in multiple myeloma, and the impact of novel agents. J Clin Oncol. 2010;28(15):2612-24.
Malcovati L, Porta MG, Pascutto C, Invernizzi R, Boni M, Travaglino E, et al. Prognostic factors and life expectancy in myelodysplastic syndromes classified according to WHO criteria: a basis for clinical decision making. J Clin Oncol. 2005;23(30):7594- 603.
Pardanani A, Tefferi A. Prognostic relevance of anemia and transfusion dependency in myelodysplastic syndromes and primary myelofibrosis. Haematologica. 2011;96(1):8-10.
Elena C, Passamonti F, Rumi E, Malcovati L, Arcaini L, Boveri E, et al. Red blood cell transfusion-dependency implies a poor survival in primary myelofibrosis irrespective of IPSS and DIPSS. Haematologica. 2011;96(1):167-70.
Pereira A, Nomdedeu M, Aguilar JL, Belkaid M, Carrió A, Cobo F, et al. Transfusion intensity, not the cumulative red blood cell transfusion burden, determines the prognosis of patients with myelodysplastic syndrome on chronic transfusion support. Am J Hematol. 2011;86(3):245-50.
Malcovati L, Cazzola M. The relevance of transfusion-dependency in the prognostic assessment of patients with myeloid neoplasms. Am J Hematol. 2011;86(3):241-3.
