Efficacy of Splenectomy for Hematologic Malignancies

Objective: This study aimed to define the evolving indications for splenectomy and benchmark clinical outcomes in patients with hematologic malignancies. Background: With the advent of new therapies for hematologic malignancies, the diagnostic and therapeutic indications for splenectomy have changed. However, the effectiveness of splenectomy and its postoperative complications are not well understood. Methods: This retrospective study included consecutive patients with hematologic disorders who underwent splenectomy at an NCI-designated comprehensive cancer center between 2009 and 2024. Patients were grouped by indication as lymphoid or myeloid; patients with benign conditions constituted a small descriptive subgroup. The primary outcome was the postoperative complication rate (30 d). The secondary outcome was splenectomy success based on indications. Results: A total of 79 patients were included: 37 lymphoid, 33 myeloid, 5 immune thrombocytopenic purpura (ITP), and 4 others. Indications included bridge-to-transplant (35.4%), transfusion dependence (24.0%), symptomatic cytopenia (22.8%), and splenic malignancy (17.7%). The 30-day complication rate was 49% overall (22% grade 3 or higher). While myeloid patients had a higher proportion of patients experiencing any complication compared to lymphoid patients (65.5% vs 46.4%) ( P =0.482). Success rates were 91.7% for bridge-to-transplant but lower for achieving transfusion independence in cytopenia (38.5% lymphoid patients, 40% post-transplant myeloid patients, and 40% ITP patients). Conclusions: Our results benchmark postoperative outcomes of splenectomy in a contemporary cohort with hematological malignancies. The success of splenectomy varies according to indication. Appropriate splenectomy produces favorable outcomes across a broad range of hematologic malignancies, including improved transfusion independence and successful bridging to definitive therapies.