Splenectomy for thrombocytopenia in chronic granulocytic leukemia

Splenectomy for thrombocytopenia was performed in 6 patients in the chronic phase of chronic granulocytic leukemia. The operation was performed after a prolonged thrombocytopenia, with hemorrhagic manifestations due to busulfan-related myelosuppression unresponsive to corticosteroids and frequent platelet transfusions (2 patients), and the inability to control the clinical and hemato-logic manifestations of the disease because of inordinate platelet sensitivity to chemotherapy (4 patients). There was an immediate postoperative rise in platelet count in all 6 patients which was sustained in 5 patients. The rise was rapid in 3 cases. Spleen size did not correlate with the extent of postoperative recovery. In 5 patients with bleeding and thrombocytopenia, no further hemorrhagic problems or platelet transfusions were required as long as they remained in the chronic phase of CGL. Hydroxyurea was a useful drug to control CGL in patients markedly sensitive to the thrombocytopenic effects of busulfan.