Chronic lymphocytic leukemia (CLL) is a clonal malignancy that results from expansion of the mature
lymphocyte compartment and is the most common leukemia in adults. The survival period from the time of
diagnosis of CLL varies between 2 and more than 10 years. At the time of diagnosis, most patients with chronic
lymphocytic leukemia does not need to be treated with chemotherapy until the patient is symptomatic.
Chlorambucil and cyclophosphamide were the main therapy in CLL. Cyclophosphamide is usually combined
with other agents, such as vincristine and prednisone, and incorporated into combination regimens. High response
rates were also seen with anthracycline regimens. Purine analogues are currently used in CLL. Because of the
difficulty in eradicating CLL cells from bone marrow peripheral blood, autologous transplantation is widely used.
Rituximab, an anti-CD20 monoclonal antibody, has recently provoked interest for the treatment of CLL. Perhaps
the most potent regimen for CLL is the combination of the most effective single chemotherapeutic agent with the
most effective monoclonal antibody. Splenectomy is helpful in the management of selected patients with CLL,
who do not present adequate response to clinical therapy in an attempt to reduce the resistance to drugs and to
alleviate the symptoms provoked by the huge size of the spleen. Besides the advantages of splenectomy, it must
be stressed that in most cases this procedure is accompanied by a greater morbidity and mortality. Thus a
conservative procedure that reduces the spleen size may have a similar effect to that of total spleen ablation for
treatment of CLL, without losing the important functions of this organ. Subtotal splnectomy or splenic
autotransplants after total splenectomy are worth to be considered as surgical options in presence of a
symptomatic giant spleen or a refractory patient to chemotherapy.
