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Case Report

EJMCR. 2020; 4(11): 390-394

Palliative splenic irradiation for symptomatic splenomegaly in chronic myelomonocytic leukemia - case report

Andre Pires, Isabel Rodrigues, Andre Laranja, Angelo Oliveira, Joana Goncalves.

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Background: Chronic myelomonocytic leukemia (CMML) is a rare malignant disorder that presents with splenomegaly in about 30% of cases.
Case presentation: A 71-year-old man complained of abdominal pain, left hypochondrium distension, and weight loss. After work-up, a diagnosis of CMML was conducted, and the patient started chemotherapy. After about 2 years, he experienced clinical worsening compatible with symptomatic splenomegaly, and was proposed for radiotherapy. The patient underwent palliative splenic irradiation (SI), initially with 0.25 Gy fractions, delivered every other day, but the treatment was suspended after four fractions due to thrombocytopenia; 4 weeks later, the treatment was resumed, but was suspended again after 4 × 0.25 Gy fractions due to hematological changes. The patient was kept in palliative care and died 6 weeks later.
Conclusion: SI has emerged as an alternative, widely used for palliation symptomatic splenomegaly in patients with hematological malignancies. This is the first report of SI for symptomatic splenomegaly on a patient with CMML.

Key words: Radiotherapy, splenomegaly, splenic irradiation, chronic myelomonocytic leukemia, case report

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