Role of splenectomy in the treatment of myelodysplastic syndromes with peripheral thrombocytopenia: a report on six cases
| Autor: | Christian Rose, Emmanuelle Bourgeois, Brigitte Dupriez, Francis Bauters, M T Caulier, Pierre Fenaux |
|---|---|
| Rok vydání: | 2001 |
| Předmět: |
Male
Cancer Research medicine.medical_treatment Gastroenterology Treatment Refusal Adrenal Cortex Hormones Recurrence hemic and lymphatic diseases Platelet Cellular Senescence Immunoglobulins Intravenous Leukemia Myelomonocytic Chronic Hematology Middle Aged Combined Modality Therapy Leukemia Sjogren's Syndrome Treatment Outcome Oncology Leukemia Myeloid Acute Disease Disease Progression Splenectomy Female Adult Blood Platelets Vasculitis medicine.medical_specialty Neutropenia Anemia Autoimmune Diseases Sepsis Internal medicine medicine Humans Mean platelet volume Aged Cerebral Hemorrhage Retrospective Studies Anemia Refractory with Excess of Blasts business.industry Platelet Count Myelodysplastic syndromes Danazol Anemia Refractory medicine.disease Thrombocytopenia Surgery Myelodysplastic Syndromes Interleukin-3 business Follow-Up Studies |
| Zdroj: | Leukemia. 15(6) |
| ISSN: | 0887-6924 |
| Popis: | Thrombocytopenia is generally of central origin in MDS, but can be due to peripheral platelet destruction in some cases. We studied platelet lifespan in 61 MDS cases with platelets70,000/mm3 and marrow blasts10%. Nine of them (15%) had a major platelet lifespan reduction (3.5 days), and were considered for splenectomy. Three of them were not splenectomized due to rapid death, patient refusal and older age plus liver predominance of platelet sequestration, respectively. The remaining six patients (two females and four males, median age 50 years, range 32 to 65) were splenectomized 3 to 21 months after diagnosis. Before splenectomy, five of them had RA and one had CMML. Platelets counts ranged from 5000 to 30,000/mm3 and did not durably respond to other treatments. Three of the patients has a relapse of platelet counts, concomitantly required platelet transfusion due to recurrent blending, whereas three had anemia (two required erythrocyte transfusion) and four had neutropenia. Three months after surgery, platelet counts ranged from 55,000 to 160,000/mm3 (100,000/mm3 in four cases), no patient required platelet or erythrocyte transfusion, but there was no effect on neutrophil counts. Three patients had a relapse of platelet counts, concomitant with progression to AML in two of them, whereas the third relapsing case achieved normal platelet counts with further danazol. One patient died with normal platelet counts 12 months after splenectomy (from sepsis, probably related to neutropenia rather than splenectomy). Two patients remained with normal platelet counts 10 and 52 months after surgery. Our findings suggest that the mechanism of thrombocytopenia should be studied more often in 'low risk' MDS (i.e. with low bone marrow blast counts) with thrombocytopenia, as about 15% of them appear to have peripheral platelet destruction. Some of those patients may benefit from splenectomy. |
| Databáze: | OpenAIRE |
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