Spleen Removal May Be A Treatment Option For Certain MDS Patients (ASH 2010)
Published: Jan 13, 2011 4:13 pm
Splenectomy, or removal of the spleen, may be an effective treatment option for myelodysplastic syndromes patients with less than 10 percent immature blood cells and who do not respond to blood transfusions or initial treatment with drugs that suppress the immune system.
Dr. Alina V. Kokhno presented these findings during a poster session at the 2010 American Society of Hematology (ASH) meeting last month.
The spleen is an organ that filters old red blood cells and platelets out of the blood stream. It also works to activate the immune system when an infection is detected.
The spleen may be removed when it becomes so enlarged that it is destructive to red blood cells and platelets, when a hard blow to the spleen causes it to bleed, or if cancer spreads to the organ.
Spleen removal is currently used to treat congenital erythropoietic porphyria, in which red blood cell proteins are not made properly, and congenital pyruvate kinase deficiency, in which patients do not produce a necessary protein to keep red blood cells alive.
A small number of reports have suggested that the removal of the spleen is an effective treatment for myelodysplastic syndromes (MDS) patients with immune-related low platelet counts.
Based on these results, Dr. Kokhno and her colleagues at the National Research Center for Hematology in Moscow analyzed data from 33 MDS patients who underwent spleen removal between 1994 and 2010 at their institution.
The National Research Center for Hematology uses removal of the spleen as a treatment option for MDS patients who have less than 10 percent immature blood cells and who do not respond to blood transfusions or treatment with cyclosporine (Sandimmune), a drug that suppresses the immune system.
Of the 33 patients, 27 (82 percent) were dependent on red blood cell transfusions and 22 (67 percent) were dependent on platelet transfusions. All patients underwent spleen removal at a median of 12 months after MDS diagnosis.
After spleen removal, blood counts improved in 16 patients (48 percent). Of the patients who were transfusion-dependent, 14 patients (42 percent) needed fewer infusions, and two patients (6 percent) became transfusion-independent.
Dr. Kokhno and her colleagues did not observe any increase in infection rates after the procedure.
One patient experienced excessive bleeding after the operation, and one patient died seven days after spleen removal due to progression to acute myeloid leukemia.
At a median of six months post-splenectomy, six patients (18 percent) had progressed to acute myeloid leukemia.
After a median of 12 months, 13 patients (39 percent) died, most commonly due to progression to acute myeloid leukemia or low blood cell counts that led to infections and excessive bleeding.
When the researchers followed up with the patients at a median of 33 months after spleen removal, 20 patients (61 percent) had survived.
- Re-Treatment With Revlimid Following A Short Treatment-Free Period May Result In A Second Response In Relapsed MDS Patients (ASH 2010)
- Therapeutic Vaccine Combined With Revlimid Achieves Response In High-Risk MDS Patients (ASH 2011)
- Exjade May Be More Effective Than Ferriprox In Certain Lower-Risk MDS Patients (EHA 2011)
- Dacogen Dose Can Be Reduced In MDS Patients Without Impacting Outcome Once Best Response Is Reached (ASH 2010)
- Dacogen Is Effective In Previously Treated MDS Patients (ASH 2010)