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 busulfanrelated myelosuppression unresponsive to corticosteroids and frequent platelet transfusions (2 patients), and the inability to control the clinical and hematologic 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. I n 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.
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PLENECTOMY HAS BEEN ABANDONED AS PRI-
S mary treatment for chronic granulocytic leukemia (CGL), because of the high mortality and morbidity associated with the procedure. The leukocytosis and occasional thrombocytosis of CGL rendered the surgical patient more liable to hemorrhagic complications. The unfavorable results have been further enhanced by the fact that splenectomy was usually attempted as a desperation move in patients in the blastic phase of their disease.@ Subsequently, it was noted that radiation therapy directed to the spleen prior to surgery significantly reduced the morbidity and mortality. It was apparent that splenectomy and radiation therapy offered no greater advantage than splenic irradiation alone.13 Since the introduction of cytotoxic drugs, control of the chronic phase in most cases has been relatively successful.8.18
Thrombocytopenia is usually a late manifestation of the natural course of chronic granulocytic leukemia (CGL). Most often, it is associated with transformation of the disease to the blastic phase. In a smaller number of patients, thrombocytopenia, which may be a direct manifestation of the disease process or result from an inordinate sensitivity to the mye-From the Solid Tumor