Splenectomy in patients with Hodgkin's disease has been controversial. Cytopenias in association with splenomegaly may cause a major problem in managing Hodgkin's disease by lowering the therapeutic index of the myelosuppressive chemotherapeutic agents used. Evaluated here are the results of the operation in ten patients with Hodgkin's disease who underwent splenectomy for splenomegaly and associated cytopenias during the last five years. Nine patients were in stage IV-B; one was in stage III-A. Eight had bone or marrow involvement with lymphoma or a history of treatment with extensive radiotherapy. Eight had poor tolerance to myelosuppressive drugs. There were no operative deaths and postoperative morbidity was confined to atelectasis in one patient. After splenectomy, the white count, platelet count and hematocrit rose to levels above normal in all patients, and in nine amelioration of the cytopenias persisted throughout the clinical course. Chemotherapy was administered to nine patients after splenectomy. Tolerance to the drugs with regard to myelosuppression was excellent in all, with four complete and three partial remissions among the eight patients who received chemotherapy for active disease. Seven patients are still alive, from two to thirty-three months after splenectomy; five of them are free of disease. It is concluded that splenectomy in patients with Hodgkins disease, splenomegaly and cytopenias is a useful mode of therapy to increase the ability of patients to tolerate myelosuppressive chemotherapy.
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