СПЛЕНЕКТОМІЯ У ЛІКУВАННІ ХВОРИХ НА ДИФУЗНУ В-ВЕЛИКОКЛІТИННУ ЛІМФОМУ ТА ЇЇ РЕЗУЛЬТАТИ
Keywords:
non-Hodgkin’s lymphoma, diffuse large B cell lymphoma, splenectomy, autoimmune hemolytic anemia, immune thrombocytopenia.Abstract
Objective: to analyze the immediate and long-term results of splenectomy in pa
tients with diffuse large B cell lymphoma and, as based on the results, to specify
indications for splenectomy, surgical approach and outcomes. Object and meth
ods: among 114 splenectomies in patients with non-Hodgkin’s lymphomas (NHL),
29 splenectomies were performed in patients with diffuse large B cell lymphoma
(DLBCL). Among them there were 15 men and 14 women 21–75 years old (me
dian age — 57 years). The indications for splenectomy in patients with DLBCL
were: splenomegaly, leukopenia, immune thrombocytopenia, autoimmune hemo
lytic anemia, regional portal hypertension, absence of diagnosis. The statistical
processing was performed by means of software package Statistica for Windows 6.0
(StatSoft, USA). Parametric data was presented as median (minimum-maximum)
[lower-upper quartiles]. The results of splenectomy were assessed in the immedi
ate post-splenectomy period (on the fourteenth–sixteenth day) pursuant to crite
ria described in the references and during follow-up control. The overall patients’
survival was determined by the Kaplan — Meier method and described as a medi
an survival (lower-upper quartiles) and 3- and 5-year survival was also estimated
constructing tables of cumulative survival. The survival curves were compared using
the log-rank and Cox tests. Results: splenectomy was effective in 25 (86.2%) pa
tients with DLBCL: abdominal discomfort, anemia, leukopenia were eliminated,
hemolysis associated with autoimmune hemolytic anemia stopped, and the num
ber of platelets associated with immune thrombocytopenia increased or normal
ized, and hemorrhagic syndrome disappeared. One patient died immediately af
ter splenectomy. Early postoperative mortality after splenectomy in patients with
DLBCL was 3.4%. The analysis of long-term results of splenectomy in DLBCL
patients showed that the median survival according to Kaplan — Meier curve was
31.9 months (observation period 1.0–192.0 months, the lower quartile and the
upper quartile are 5.6–72.5 months) with 3-year cumulative survival 48.7% of
patients and with 5-year — 32.9%. In patients with concomitant immune cytope
nias median survival was 6.5 months in contrast to 56.5 months in their absence.
The difference with between the groups was highly significant — p < 0.01 by log
rank criterion and Cox’s F Test. Multivariate analysis by Cox regression method
showed that in addition to cytopenia, an independent predictor of less survival is
an earlier onset of relapses, age and duration of the disease did not affect survival.
Conclusions: as a result of splenectomy in patients with DLBCL, the direct clini
cal and hematological effect occurred in 86.2% of cases. In DLBCL patients who
did not have concomitant immune cytopenias, the median survival after opera
tion was 56.5 months, in contrast to 6.5 months in the presence of immune cyto
penias. The best results of splenectomy in DLBCL were recorded in patients with
isolated spleen lesions: patients lived from 72 to 186 months
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СПЛЕНЕКТОМІЯ У ЛІКУВАННІ ХВОРИХ
НА ДИФУЗНУ В-ВЕЛИКОКЛІТИННУ
ЛІМФОМУ ТА ЇЇ РЕЗУЛЬТАТИ
