Splenectomy in hairy cell leukemia: a retrospective multicenter analysis.

To study the effect of splenectomy in hairy cell leukemia, we initiated a retrospective multicenter analysis. A series of 391 patients, contributed by 22 centers (median: 15 cases per center, range 2--130), was analyzed. Since comparison of the data from these centers showed few significant differences, the data were pooled. Factors that proved to have prognostic value at the time of diagnosis was significantly longer in the splenectomy group (n = 225) than in the nonsplenectomy group (n = 166) (P less than 0.0001). When subgroups were analyzed, no difference in survival time was found between splenectomized and splenectomized patients having an age greater than 60 years, symptoms greater than 12 months, spleens less than 4 cm under costal margin, hemoglobin levels greater than 12 g/dl, neutrophils greater than 500/mm3, or platelets greater than 100,000/mm3. After the operation, the platelet count usually increased to acceptable values, whereas the neutrophil count increased less often. Patients with Hb greater than 11 g/dl, neutrophils greater than 1,000/mm3, and platelets greater than 100,000/mm3 after splenectomy, survived longer than patients with a less complete response to the operation (P less than 0.01). In patients with definite splenomegaly and pancytopenia, splenectomy seems to be beneficial. However, in patients without distinctly enlarged spleens, other therapeutical modalities should be considered.