Treatment options for primary splenic low-grade non-Hodgkin's lymphomas

Abstract

The purpose of this comparative study was to evaluate the response of primary splenic low-grade non-Hodgkin's lymphomas (NHL) to chemotherapy, splenectomy, and chemotherapy combined with splenectomy in order to elaborate the optimum treatment modality. A total of 104 patients (age range: 15-82 years) with primary low-grade B-cell NHL of the spleen were comprised by our study. Stage IV disease was determined in 102 (98.1%) cases. Regarding the treatment modality, splenectomy was performed in 14 patients, early splenectomy and single-agent chemotherapy in 15, early splenectomy and combined chemotherapy in 19, single-agent chemotherapy in 23, and combined chemotherapy in 33. In the above-mentioned order, complete remission rate was following: none, 40.0, 31.6, 21.8, and 18.2%. Partial remissions were achieved in 85.7, 46.7, 57.9, 30.4, and 69.7% of cases, respectively. The median remission duration turned out to be longer (74.5 months) in the group of patients with complete remissions attained by means of splenectomy and combined chemotherapy. Local relapses in the spleen developed in 19 (72.7%) patients treated with combined chemotherapy and in 9 (90.0%), who had undergone single-agent chemotherapy. The 5-year overall survival was 54.4% after splenectomy, 39.4% after single-agent chemotherapy, and 37.1% after combined chemotherapy, being significantly higher (P <0.05) after splenectomy and single-agent chemotherapy (67.2%), and splenectomy followed by combined chemotherapy (64.7%). Early splenectomy combined with chemotherapy is the optimum treatment option for primary low-grade NHL of the spleen because of the superiority in complete remission rate, remission duration, and in overall survival rate. Splenectomy leads to somatic compensation of patients, makes impossible local relapsing in the spleen, prevents continuous dissemination from the primary tumor site, and mostly corrects cytopenias, creating better conditions for chemotherapy.

Surgical approach of primary splenic lymphoma: report of a case and review of the literature

“…Recent additional modifi cation refers to slight potential involvement of liver and/or bone marrow. Enlarged nodes beyond the splenic hilum indicate advanced disease inconsistent with PSL [10]. Extended range of gross pathological manifestations explains the variety of radiological appearances and relative diffi culty in accurate radiographic diagnostic process identifi ed in our patient.…”

Multi-Database Description of Primary Splenic Diffuse Large B-Cell Lymphoma

“…However, since the advent of rituximab, some have suggested that splenectomy can be abandoned as first-line treatment for splenic MZL as rituximab alone has 88-100% response rate (23,24). Moreover, Musteata et al suggested that early splenectomy along with combination chemotherapy was the optimal treatment for low-grade PSL, leading to higher response rates, progression-free survival, and OS compared to chemotherapy alone (25). For those unable to undergo splenectomy, local radiotherapy has historically been considered for low-grade PSL (25).…”

Primarysplenic Large Cell B Lymphoma: Case Report

“…A study of 104 patients with primary low grade non-Hodgkin lymphoma of the spleen concluded that early splenectomy along with the combination of chemotherapy was the optimal treatment due to higher rates of remission, a more prolonged duration of remission and better overall survival rates when compared with splenectomy or splenectomy with a single agent chemotherapy [15] . Most cases of aggressive subtype (DLBC, ALCL) show disease expansion and progression, requiring appropriate chemotherapy.…”