Abstract
A 51-year-old man was found to have Ph1 chromosome-positive CML in August 1971. He was treated by busulfan for 47 months and by carbazilquinone for the following 8 months. In August 1976, he was pale and the spleen was enlarged 8.5 fb below the left costal margin. WBC was 11,000/mm3 with 12% blasts. A bone marrow biopsy showed severe myelofibrosis. A diagnosis of the early stage of blastic crisis was made. On september 30, the spleen, weighing 1,010 gm, was removed. On the seventh postoperative day WBC fell to 5,000/mm3 with a normal differential cell count. The patient's condition improved and he could work for 3 months. In January 1977, WBC was 54,000/mm3 with 28% blasts. Antileukemic treatment with vincristine, prednisolone and 6-MP caused the fall in the peripheral blasts for 4 months, but death occurred 9 months after splenectomy. In the late stage of the disease he had persistent fever with no evidence of bacterial and fungal infection.
The value of splenectomy in CML with blastic crisis is very difficult to evaluate because of the great variation in symptoms of blastic crisis. It was concluded, however, that this case had some obvious benefits such as relief from abdominal discomfort and hemorrhage usually experienced in non-splenectomized patients with blastic crisis.
There was an increase in colony forming cell (CFU-c) in the early stage of blastic crisis when compared with that in the stage before it. The CFU-c rapidly decreased to 0 after the splenectomy. It is likely that the spleen was an important site for the production of CFU-c in the peripheral blood in this case.
