The role of splenectomy in myelofibrosis with myeloid metaplasia

Aim. In this paper we retrospectively analyzed prospectively-collected data on our myelofibrosis with myeloid metaplasia (MMM) patients who underwent splenectomy. The aim was to ascertain the hematological response and any resolution of symptoms existing prior to splenectomy; redefining timing and role of splenectomy in the treatment of MMM. Methods. This prospective study considered 31 patients with MMM who underwent splenectomy for transfusion-dependent anemia, thrombocytopenia, abdominal swelling and pain. Postoperative work-up consisting in laboratory tests and clinical evaluation performing a quality of life (QoL) test based on EORTC QLQ-C30 questionnaire. Follow-up data were collected for one year after surgery. Statistical analysis used Student's t-test, the Mann-Whitney rank sum, Fisher's exact test, the Friedman test and the Wilcoxon test. Results. Mortality was 3.2%. Respiratory symptomatic complications occurred in 35.4%. In all patients the need for blood transfusions was significantly reduced (P=0.005). An improvement in the painful symptoms was reported and a significant improve of postoperative quality of life was observed at one year after surgery. Conclusion. In our experience splenectomy is associated with limited perioperative mortality and morbidity. Acute complications are almost exclusively limited to respiratory tract. The removal of spleen seems can be recommended to increase the QoL and to palliate hematological disorders in patients no more responder to chemotherapy.