James P Wilmot Cancer Institute, Division of Hematology and Medical Oncology, University of Rochester School of Medicine and Dentistry, Rochester, NY, USA.
James P Wilmot Cancer Institute, Division of Hematology and Medical Oncology, University of Rochester School of Medicine and Dentistry, Rochester, NY, USA.
Leuk Res. 2023 May;128:107053. doi: 10.1016/j.leukres.2023.107053. Epub 2023 Mar 2.
Splenic B-cell lymphomas are rare and understudied entities. Splenectomy is frequently required for specific pathological diagnosis in patients with splenic B-cell lymphomas other than classical hairy cell leukemia (cHCL), and can be effective and durable therapy. Our study investigated the diagnostic and therapeutic role of splenectomy for non-cHCL indolent splenic B-cell lymphomas.
Observational study of patients with non-cHCL splenic B-cell lymphoma undergoing splenectomy between 1 August 2011 and 1 August 2021 at the University of Rochester Medical Center. The comparison cohort was patients categorized as having non-cHCL splenic B-cell lymphoma who did not undergo splenectomy.
Forty-nine patients (median age 68 years) had splenectomy (SMZL n = 33, HCLv n = 9, SDRPL n = 7) with median follow up of 3.9 years post splenectomy. One patient had fatal post-operative complications. Post-operative hospitalization was ≤ 4 days for 61% and ≤ 10 days for 94% of patients. Splenectomy was initial therapy for 30 patients. Of the 19 patients who had previous medical therapy, splenectomy changed their lymphoma diagnosis in 5 (26%). Twenty-one patients without splenectomy were clinically categorized as having non-cHCL splenic B-cell lymphoma. Nine required medical treatment for progressive lymphoma and of these 3 (33%) required re-treatment for lymphoma progression compared to 16% of patients following first line splenectomy.
Splenectomy is useful for the diagnosis of non-cHCL splenic B-cell lymphomas with comparable risk/benefit profile and remission duration to medical therapy. Patients with suspected non-cHCL splenic lymphomas should be considered for referral to a high-volume center with experience in performing splenectomies for definitive diagnosis and treatment.
脾 B 细胞淋巴瘤较为罕见且研究较少。除经典型毛细胞白血病（cHCL）外，其他脾 B 细胞淋巴瘤患者通常需要脾切除术进行特定的病理诊断，且该手术可能是一种有效且持久的治疗方法。我们的研究旨在探讨脾切除术在非 cHCL 惰性脾 B 细胞淋巴瘤中的诊断和治疗作用。
这是一项在罗彻斯特大学医学中心于 2011 年 8 月 1 日至 2021 年 8 月 1 日期间接受脾切除术的非 cHCL 脾 B 细胞淋巴瘤患者的观察性研究。对照组为未接受脾切除术且被归类为患有非 cHCL 脾 B 细胞淋巴瘤的患者。
49 例患者（中位年龄 68 岁）接受了脾切除术（SMZL n=33，HCLv n=9，SDRPL n=7），术后中位随访时间为 3.9 年。1 例患者发生致命性术后并发症。61%的患者术后住院时间≤4 天，94%的患者术后住院时间≤10 天。30 例患者初始接受脾切除术治疗。在 19 例先前接受过医疗治疗的患者中，脾切除术改变了 5 例（26%）患者的淋巴瘤诊断。21 例未行脾切除术的患者临床诊断为非 cHCL 脾 B 细胞淋巴瘤。9 例因进行性淋巴瘤需要接受药物治疗，其中 3 例（33%）因淋巴瘤进展需要再次治疗，而首次行脾切除术的患者中，有 16%需要再次治疗。
脾切除术对于非 cHCL 脾 B 细胞淋巴瘤的诊断具有一定作用，其风险/获益比和缓解持续时间与药物治疗相当。疑似患有非 cHCL 脾淋巴瘤的患者应考虑转至具有脾切除术经验的高容量中心，以明确诊断和治疗。
