From the Guidelines
Hydroxyurea is the first-line treatment of choice for symptomatic splenomegaly in mono treatment, as it can reduce spleen volume in approximately 40% of patients. The management of splenomegaly in mono treatment involves several options, including:
- Hydroxyurea, which is also used for controlling symptomatic thrombocytosis and/or leukocytosis 1
- Alternative myelosuppressive agents, such as intravenous cladribine, oral melphalan, and oral busulphan, for hydroxyurea-refractory disease 1
- Involved-field radiotherapy, which provides symptomatic relief of mechanical discomfort from hepatosplenomegaly, but has a transient response and is associated with a greater than 10% mortality rate from consequences of cytopenia 1
- Splenectomy, which remains a viable treatment option for drug-refractory splenomegaly 1
The choice of treatment depends on the severity of symptoms and the patient's response to initial therapy. Hydroxyurea is currently the preferred treatment due to its efficacy and relatively low risk of side effects. It is essential to monitor the patient's condition closely and adjust the treatment plan as needed to minimize the risk of complications and improve quality of life.
From the Research
Splenomegaly in Mono Treatment
- Splenomegaly occurs in approximately 50% of cases of infectious mononucleosis, a condition caused by Epstein-Barr virus 2.
- The treatment for infectious mononucleosis, including splenomegaly, is mainly supportive, with reduction of activity and bed rest as tolerated recommended 2.
- Patients with splenomegaly due to infectious mononucleosis should avoid contact sports or strenuous exercise for 8 weeks or while splenomegaly is still present to minimize the risk of splenic rupture 2, 3.
- Splenic rupture is a rare but potentially life-threatening complication of infectious mononucleosis, occurring in 0.1 to 0.5% of patients 2.
- The management of splenomegaly involves treating the underlying disease process, and in some cases, splenectomies or spleen reduction therapies may be performed 4, 5.
Diagnosis and Investigation
- The diagnosis of splenomegaly due to infectious mononucleosis is based on clinical manifestations, evaluation, and diagnosis, including the demonstration of heterophile antibodies 2.
- Abdominal ultrasonography is recommended for confirmation of splenomegaly 5.
- Basic laboratory analysis and ultrasonography are the first-line steps in determining the etiology of splenomegaly, except for apparent causes such as infectious mononucleosis 5.
Complications and Prevention
- Acute infections, anemia, and splenic rupture are the most common complications of splenomegaly 5.
- People with splenomegaly should refrain from participating in contact sports to decrease the risk of rupture 5.
- The development of an effective, safe, and affordable EBV vaccine that can confer life-long immunity is the most effective way to prevent EBV infection and infectious mononucleosis 2.