Get 20M+ Full-Text Papers For Less Than $1.50/day. Start a 14-Day Trial for You and Your Team.

Learn More →

Splenectomy in Agnogenic Myeloid Metaplasia and Postpolycythemic Myeloid Metaplasia: A Study of 34 Cases

Splenectomy in Agnogenic Myeloid Metaplasia and Postpolycythemic Myeloid Metaplasia: A Study of... Abstract • 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. (Arch Intern Med 1988;148:2501-2505) References 1. Hickling RA: Chronic non-leukemic myelosis. Q J Med 1937;6:253-275. 2. Cole WH, Majarakis JD, Limarzi LR: Surgical aspects of splenic disease. Arch Surg 1955;71:33-46.Crossref 3. Crosby WH: Splenectomy in hematologic disorders. N Engl J Med 1972;286:1252-1256.Crossref 4. Mulder H, Steenbergen J, Haansen C: Clinical course and survival after elective splenectomy in 19 patients with primary myelofibrosis. Br J Haematol 1977;35:419-427.Crossref 5. Silverstein MN, ReMine WH: Splenectomy in myeloid metaplasia. Blood 1979;53:515-518. 6. Varki A, Lottenberg R, Griffith R, et al: The syndrome of idiopathic myelofibrosis. Medicine 1983;62:353-371.Crossref 7. Silverstein MN: Agnogenic myeloid metaplasia , in Williams JW, Beutler E, Erslev AJ, et al (eds): Hematology , ed 3. New York, McGraw-Hill International Book Co, 1983, pp 214-218. 8. Ellis JT, Peterson P, Geller SA, et al: Studies of the bone marrow in polycythemia vera and the evolution of myelofibrosis and second hematologic malignancies. Semin Hematol 1986;23:144-155. 9. Ivy AC, Shapiro PF, Melnick P: The bleeding tendency in jaundice. Surg Gynecol Obstet 1935;60:781-784. 10. Benbassat J, Penchas S, Ligumski M: Splenectomy in patients with agnogenic myeloid metaplasia: An analysis of 321 published cases. Br J Haematol 1979;42:207-214.Crossref 11. Silverstein MN: Agnogenic Myeloid Metaplasia . Acton, Mass, Publishing Science Group, 1975, pp 109-114. 12. Silverstein MN: Postpolycythemia myeloid metaplasia. Arch Intern Med 1974;134:113-116.Crossref 13. Milner JR, Geary CG, Wadsworth LD, et al: Erythrokinetic studies as a guide to the value of splenectomy in primary myeloid metaplasia. Br J Haematol 1973;25:467-484.Crossref 14. Jacobs P, Maze S, Tayob F, et al: Myelofibrosis splenectomy and portal hypertension. Acta Haematol 1985;74:45-48.Crossref 15. Brenner B, Tavori S, Tatarsky I: Influence of splenectomy on hemostasis in agnogenic myeloid metaplasia. Haemostasis 1987;17:141-146. 16. Budde U, Schaefer G, Mueller N, et al: Acquired von Willebrand's disease in the myeloproliferative disorders. Blood 1984;64:981-985. 17. Magee C, Rodeheaver GT, Golden GT, et al: Potentiation of wound infection by surgical drains. Am J Surg 1976;131:547-549.Crossref 18. Halpern A, Nagler A, Argov S, et al: Post-splenectomy infections in 208 traumatized splenectomized patients. Digestive Surg 1985;5:22-24. 19. Gordon BR, Coleman M, Kohen P, et al: Immunologic abnormalities in myelofibrosis with activation of the complement system. Blood 1981;58:904-910. 20. Malmaeus J, Akre T, Adami HO, et al: Early post-operative course following elective splenectomy in haematological diseases: A high complication rate in patients with myeloproliferative disorders. Br J Surg 1986;73:720-723.Crossref 21. Barosi G, Baraldi A, Cazzola M, et al: Polycythaemia following splenectomy in myelofibrosis with myeloid metaplasia. Scand J Haematol 1984;32:12-18.Crossref 22. Schafer AI: Bleeding and thrombosis in the myeloproliferative disorders. Blood 1984;64:1-12. 23. Landaw SA: Acute leukemia in polycythemia vera. Semin Hematol 1986;23:156-165. 24. Kaplan ME, Mack K, Goldberg JD, et al: Long term management in polycythemia vera with hydroxyurea: A progress report. Semin Hematol 1986;23:167-171. 25. Sharon R, Tatarsky I, Ben-Arieh Y: Treatment of polycythemia vera with hydroxyurea. Cancer 1986;57:718-720.Crossref 26. Benbassat J, Penchas S: 'Early' splenectomy and survival in agnogenic myeloid metaplasia: An analysis of 338 cases published since 1940. Acta Haematol 1981;65:189-192.Crossref 27. Besa EC, Nowell PC, Geller NC, et al: Analysis of the androgen response of 23 patients with agnogenic myeloid metaplasia: The value of chromosomal studies in predicting response and survival. Cancer 1982;49:308-313.Crossref 28. Wagner H, McKeough PG, Desforges J, et al: Splenic irradiation in the treatment of patients with chronic myelogenous leukemia or myelofibrosis with myeloid metaplasia. Cancer 1986;58:1204-1207.Crossref http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Archives of Internal Medicine American Medical Association

Splenectomy in Agnogenic Myeloid Metaplasia and Postpolycythemic Myeloid Metaplasia: A Study of 34 Cases

Loading next page...
 
/lp/american-medical-association/splenectomy-in-agnogenic-myeloid-metaplasia-and-postpolycythemic-WGsjJcOnBg
Publisher
American Medical Association
Copyright
Copyright © 1988 American Medical Association. All Rights Reserved.
ISSN
0003-9926
eISSN
1538-3679
DOI
10.1001/archinte.1988.00380110129028
Publisher site
See Article on Publisher Site

Abstract

Abstract • 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. (Arch Intern Med 1988;148:2501-2505) References 1. Hickling RA: Chronic non-leukemic myelosis. Q J Med 1937;6:253-275. 2. Cole WH, Majarakis JD, Limarzi LR: Surgical aspects of splenic disease. Arch Surg 1955;71:33-46.Crossref 3. Crosby WH: Splenectomy in hematologic disorders. N Engl J Med 1972;286:1252-1256.Crossref 4. Mulder H, Steenbergen J, Haansen C: Clinical course and survival after elective splenectomy in 19 patients with primary myelofibrosis. Br J Haematol 1977;35:419-427.Crossref 5. Silverstein MN, ReMine WH: Splenectomy in myeloid metaplasia. Blood 1979;53:515-518. 6. Varki A, Lottenberg R, Griffith R, et al: The syndrome of idiopathic myelofibrosis. Medicine 1983;62:353-371.Crossref 7. Silverstein MN: Agnogenic myeloid metaplasia , in Williams JW, Beutler E, Erslev AJ, et al (eds): Hematology , ed 3. New York, McGraw-Hill International Book Co, 1983, pp 214-218. 8. Ellis JT, Peterson P, Geller SA, et al: Studies of the bone marrow in polycythemia vera and the evolution of myelofibrosis and second hematologic malignancies. Semin Hematol 1986;23:144-155. 9. Ivy AC, Shapiro PF, Melnick P: The bleeding tendency in jaundice. Surg Gynecol Obstet 1935;60:781-784. 10. Benbassat J, Penchas S, Ligumski M: Splenectomy in patients with agnogenic myeloid metaplasia: An analysis of 321 published cases. Br J Haematol 1979;42:207-214.Crossref 11. Silverstein MN: Agnogenic Myeloid Metaplasia . Acton, Mass, Publishing Science Group, 1975, pp 109-114. 12. Silverstein MN: Postpolycythemia myeloid metaplasia. Arch Intern Med 1974;134:113-116.Crossref 13. Milner JR, Geary CG, Wadsworth LD, et al: Erythrokinetic studies as a guide to the value of splenectomy in primary myeloid metaplasia. Br J Haematol 1973;25:467-484.Crossref 14. Jacobs P, Maze S, Tayob F, et al: Myelofibrosis splenectomy and portal hypertension. Acta Haematol 1985;74:45-48.Crossref 15. Brenner B, Tavori S, Tatarsky I: Influence of splenectomy on hemostasis in agnogenic myeloid metaplasia. Haemostasis 1987;17:141-146. 16. Budde U, Schaefer G, Mueller N, et al: Acquired von Willebrand's disease in the myeloproliferative disorders. Blood 1984;64:981-985. 17. Magee C, Rodeheaver GT, Golden GT, et al: Potentiation of wound infection by surgical drains. Am J Surg 1976;131:547-549.Crossref 18. Halpern A, Nagler A, Argov S, et al: Post-splenectomy infections in 208 traumatized splenectomized patients. Digestive Surg 1985;5:22-24. 19. Gordon BR, Coleman M, Kohen P, et al: Immunologic abnormalities in myelofibrosis with activation of the complement system. Blood 1981;58:904-910. 20. Malmaeus J, Akre T, Adami HO, et al: Early post-operative course following elective splenectomy in haematological diseases: A high complication rate in patients with myeloproliferative disorders. Br J Surg 1986;73:720-723.Crossref 21. Barosi G, Baraldi A, Cazzola M, et al: Polycythaemia following splenectomy in myelofibrosis with myeloid metaplasia. Scand J Haematol 1984;32:12-18.Crossref 22. Schafer AI: Bleeding and thrombosis in the myeloproliferative disorders. Blood 1984;64:1-12. 23. Landaw SA: Acute leukemia in polycythemia vera. Semin Hematol 1986;23:156-165. 24. Kaplan ME, Mack K, Goldberg JD, et al: Long term management in polycythemia vera with hydroxyurea: A progress report. Semin Hematol 1986;23:167-171. 25. Sharon R, Tatarsky I, Ben-Arieh Y: Treatment of polycythemia vera with hydroxyurea. Cancer 1986;57:718-720.Crossref 26. Benbassat J, Penchas S: 'Early' splenectomy and survival in agnogenic myeloid metaplasia: An analysis of 338 cases published since 1940. Acta Haematol 1981;65:189-192.Crossref 27. Besa EC, Nowell PC, Geller NC, et al: Analysis of the androgen response of 23 patients with agnogenic myeloid metaplasia: The value of chromosomal studies in predicting response and survival. Cancer 1982;49:308-313.Crossref 28. Wagner H, McKeough PG, Desforges J, et al: Splenic irradiation in the treatment of patients with chronic myelogenous leukemia or myelofibrosis with myeloid metaplasia. Cancer 1986;58:1204-1207.Crossref

Journal

Archives of Internal MedicineAmerican Medical Association

Published: Nov 1, 1988

References