Chronic Granulocytic Leukaemia: Effect of Elective Splenectomy on the Course of Disease

Authors:
  • ASA. S. D. Spiers
    A. S. D. Spiers
  • ABA. G. Baikie
    A. G. Baikie
  • DGD. A. G. Galton
    D. A. G. Galton
  • HRH. G. H. Richards
    H. G. H. Richards
  • EWE. Wiltshaw
    E. Wiltshaw
  • JGJ. M. Goldman
    J. M. Goldman
  • DCD. Catovsky
    D. Catovsky
  • JSJ. Spencer
    J. Spencer
  • RPR. Peto
    R. Peto
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Abstract
Conventional treatment by drugs or irradiation produces little prolongation of life in patients with chronic granulocytic leukaemia (C.G.L.) because the onset of metamorphosis of the disease from a chronic to an acute or subacute leukaemic process is not substantially postponed. Isolated clinical observations as well as both cytogenetic and cytokinetic evidence suggest that the spleen may play a special though not exclusive role in the development of undifferentiated cell clones which lead to metamorphosis of C.G.L. The results of a study of elective splenectomy during the chronic phase of the disease are reported. Twenty-six patients with C.G.L. underwent splenectomy during clinical remission of their disease, and there were no deaths after the operation. Twenty-one patients were alive at the time of writing, two of them eight years after splenectomy. Five cases of metamorphosis of C.G.L. to a refractory phase occurred whereas 10 would have been expected, a significant difference. After the onset of metamorphosis the quality of life was better in splenectomized than in non-splenectomized patients. These results show that splenectomy is a reasonable and safe procedure in C.G.L., and its apparently beneficial effects on prognosis justify a larger controlled clinical trial.

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