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Laparoscopic Splenectomy Safe, Effective for Autoimmune Haemolytic Anaemia in Chronic Lymphocytic Leukaemia

Laparoscopic splenectomy is both safe and effective in patients with chronic lymphocytic leukaemia (CLL) with autoimmune haemolytic anaemia that is refractory to medical management, report researchers from the United States.

Laparoscopic splenectomy is an alternative treatment for patients who fail medical management for autoimmune haemolytic anaemia; however, the clinical utility of this procedure in patients with CLL is uncertain.

In this study, John Hill, MD, and colleagues, Cleveland Clinic Foundation, Ohio, retrospectively evaluated the safety and efficacy of laparoscopic splenectomy in 9 patients with CLL with autoimmune haemolytic anaemia. The patients had been previously treated with alkylating agents and/or purine analogues for CLL. All had failed initial treatment with corticosteroids for autoimmune haemolytic anaemia, and 5 patients also failed intravenous immunoglobulin treatment.

Overall, 78% of patients achieved a complete response of their autoimmune haemolytic anaemia after splenectomy. One of these patients relapsed at 12 weeks. At a mean follow-up of 24 months (range of 9-43 months), therefore, 67% remained in complete remission. Of the 2 patients who did not respond, 1 died 19 days after surgery with no evidence of response and 1 showed no response to treatment 5 months after splenectomy.

Treatment was well tolerated, with no immediate postoperative complications seen in 78% of the patients. In 2 patients who developed complications, 1 died of complications of Hodgkin's disease 19 days after surgery and 1 developed pneumonia. Splenectomy had no effect on preoperative immune-mediated thrombocytopenia documented in 2 patients who achieved complete response after splenectomy.

The authors conclude that most patients with CLL with autoimmune haemolytic anaemia can expect some response from laparoscopic splenectomy, as well as durable remissions indicative of cure. However, they add that these good results are tempered by the lack of effect splenectomy had on preoperative immune-mediated thrombocytopenia in 2 patients, as well as by the fact that all long-term responders were subsequently treated further for CLL.

Am J Hematol 2004 Mar;75:3:134-8. "Laparoscopic splenectomy for autoimmune hemolytic anemia in patients with chronic lymphocytic leukemia: A case series and review of the literature"

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