Effect of splenectomy on tolerance to combination chemotherapy in patients with lymphoma.

Enhanced tolerance to combination chemotherapy has been cited as an ancillary benefit of staging laparotomy and splenectomy in Hodgkin's disease. Seventeen patients with Hodgkin's disease and 15 with non-Hodgkin's lymphoma were subjected to nontherapeutic splenectomy as part of the staging procedure prior to their initial treatment with MOPP (nitrogen mustard, vincristine, procarbazine, and prednisone) or CVP (cyclophosphamide, vincristine, and prednisone) chemotherapy, respectively. Matched control patients of comparable age, pathologically proven stage, and presence or absence of bone marrow lymphoma and previous radiotherapy were selected. Although leukocyte (in non-Hodgkin's patients) and platelet counts (in both groups) were significantly higher in the patients with splenectomy during most of the first six cycles of therapy, there was no difference in the number of cycles during which a leukocyte count below 1000 (or below 2000 in Hodgkin's disease) or platelet count below 50,000 was recorded in the splenectomized and control patients. The total dose of all drugs actually delivered, time required to complete six cycles of treatment, and the portion of patients entering complete remission were not significantly different in the two groups. We have found no evidence that splenectomy per se, in lymphoma patients without findings of hypersplenism, improves the ability to administer planned amounts of drugs during initial combination chemotherapy.