Three adult cases of peroxidase-negative acute leukemia with splenomegaly during hematological remissions were reported.
In each case the first hematological remission lasted for a long period of time in spite of persistent splenomegaly after its induction. The survival periods after diagnosis were 55 and 65 months, respectively, in two patients, and the remaining patient is still alive in hematological remission 41 months after diagnosis. Two of the three patients underwent splenectomy during hematological remissions to reveal no leukemic cell infiltration in their spleens. Splenomegaly, weighing about 400 grams in both cases, was ascribed mainly to congestion. After splenectomy they could well tolerate to potent antileukemic chemotherapies as evidenced by unusually mild cytopenias.
Based on clinical features and histopathologic findings of resected spleens in these cases, the role of splenectomy in the management of patients with acute leukemia and the significance of splenomegaly as a criterion for complete remission were discussed.