Spleen and Immune System
Introduction
Splenectomy was previously performed on a routine basis in patients with Hodgkin lymphoma (HL) as part of a staging laparotomy. This was because it was very difficult to know if the spleen was involved by HL purely on the basis of a CT scan. Pathology analysis of the spleen was far more accurate and guided clinical decision making. With increasingly effective systemic therapy and improved functional diagnostic imaging (PET-CT scan), splenectomy in this context has been abandoned.
Patients treated for HL in the past 10 years or so are very unlikely indeed to have had a splenectomy – however this surgery is still performed for haematological conditions such as hereditary spherocytosis and sickle cell disease.
Long term survivors of HL treated more than 10 years ago may have had a splenectomy and it is very important that this is documented. They are at risk of serious infections (most commonly fulminant pneumococcal sepsis). There is no evidence that splenectomy increases the risk of developing a second malignant neoplasm1.
Radiation therapy RT)
- Can cause splenic dysfunction and asplenism
- RT doses over 30 Gy are very likely to make the spleen non-functional and atrophied
- Fulminant pneumococcal sepsis has been reported after splenic RT2
Low-dose involved-field RT (21 Gy) combined with multiagent chemotherapy does not appear to adversely affect splenic function
Splenectomy significantly increases the risk of life-threatening invasive bacterial infection.
