The significance of splenomegaly in 101 adults with acute lymphoblastic leukemia (ALL) at presentation and during remission

101 adult patients with ALL were analyzed to determine the prognostic implications of splenomegaly occuring at any time during the course of their illness. The clinical status of the spleen at presentation was not found to be of major prognostic significance. Complete response rates, remission durations, and survivals did not differ between patients with and without splenomegaly at presentation. An enlarged spleen accompanied relapse in 4 patients. In 6 additional patients, splenomegaly was present during complete remission, and splenectomies performed in 5 of these patients revealed no evidence of leukemia to account for the splenomegaly. Splenectomy does not appear to be detrimental, as all 5 patients are currently in complete remission from 20 to 63 mo after splenectomy. Evidence implicating the spleen as a source of an antibody directed against autologous leukemia cells in one patient is reviewed.