Splenectomy and chemotherapy in acute myelocytic leukemia of childhood

This study was undertaken to explore the therapeutic and diagnostic value of splenectomy for children with acute myelocytic leukemia (AML) in remission. Of 29 consecutive untreated patients entering the study, 19 attained complete remission with mercaptopurine, vincristine, and 6-azauridine. Chemotherapy during remission consisted of mercaptopurine daily and cytosine arabinoside weekly. Because remission lasted 2 months or less in 5 patients, they did not undergo splenectomy. Fourteen patients underwent splenectomy while clinically in complete remission. Splenectomy was tolerated well with no major complications. Gross abnormalities of the abdominal organs were found in 11 patients. Histologic leukemia was found in 12 patients, most often in the spleen. Negro children did not respond to therapy as well as Caucasian children. Central nervous system (CNS) leukemia terminated clinical remission in 7 of the 14 patients. Four patients remain in initial CNS and hematologic remission for 18 to 24 months, and four others remain in initial hematologic remission for 16 to 18 months. These results suggest that in children with AML, splenectomy may influence the activity of leukemia and prolong the duration of remission.