Splenectomy for hairy cell leukemia. A clinical review of 63 patients.

To further define the role of splenectomy in hairy cell leukemia (HCL), 63 patients who underwent splenectomy for symptomatic cytopenias or splenomegaly associated with HCL were reviewed. Hematologic response to splenectomy was assessed 6 months postsplenectomy by a modification of Catovsky's criteria. The prognostic value of individual clinical findings, hematologic parameters, spleen size, and Jansen stage were examined by the Cox proportional hazards model. Twenty-one patients were excluded from hematologic response analysis for the following reasons: eight patients died between 1 and 6 months after splenectomy was performed; in seven patients hematologic data were unavailable; and six patients did not have significant preoperative cytopenias. Of 42 remaining patients, hematologic response was complete in 67%, partial in 19%, and there was no response in 14%. Overall, 44% of patients had disease progression within 5 years of splenectomy. Thirteen patients had a leukemic progression 1 year after splenectomy was performed. Overall 5-year survival was 61%. There was no operative mortality (30-day), and only 9% of patients had complications. Survival rates after complete, partial, and no response were 62%, 57%, and 75%, respectively at 5 years. Preoperative clinical findings, hematologic data, spleen size, or Jansen stage were not predictive of survival. Despite the absence of identifiable prognostic criteria, splenectomy continues to be advocated for symptomatic cytopenias and splenomegaly of hairy cell leukemia because of its safety and efficacy.