Splenectomy patients tolerate PRRT better with 3x less leukocyte decline at 24 months | Research

The takeaway

Splenectomized NET patients showed significantly lower hematologic toxicity during PRRT, with 12.8% leukocyte decline at 24 months versus 47.2% in non-splenectomized patients, suggesting they may tolerate intensified treatment regimens.

12.8% vs 47.2% leukocyte decline
Splenectomized patients had nearly 4x less blood cell damage during PRRT, potentially enabling more treatment cycles

What the researchers found

Leukocyte decline at 24 months: 12.8% (splenectomized) vs 47.2% (non-splenectomized), p significant. Lower leukopenia rates. Better lymphocyte/neutrophil preservation. 34 matched pairs. 2009-2022.

Why it matters

Hematologic toxicity limits PRRT cycles. Knowing splenectomized patients tolerate PRRT better enables clinicians to consider more aggressive treatment for these patients, who often have pancreatic NETs with poorer prognosis.

How the study worked

Multicenter retrospective matched-pair analysis. 68 patients (34 splenectomized matched to 34 non-splenectomized). Blood counts at baseline, 12, and 24 months. CTCAE grading. Bonferroni correction.

What this study cannot tell us

Retrospective. 34 pairs is moderate. Matching may not capture all confounders. Splenic accumulation mechanism assumed but not directly measured.

How to read the evidence

Multicenter matched-pair retrospective study with appropriate statistical methods. Good evidence for treatment optimization.

When this study was published

Published in 2025; data 2009-2022.

The bigger picture

This has practical implications for treatment intensification. Pancreatic NET patients—who frequently undergo splenectomy during surgery—may be ideal candidates for extended PRRT courses or reinduction therapy.

Questions still open

Should splenectomized patients receive more PRRT cycles?
Could splenic shielding during PRRT reduce hematotoxicity in non-splenectomized patients?
Is the reduced toxicity large enough to improve overall survival through intensified treatment?

Common questions

Why does spleen removal affect PRRT side effects?

The spleen naturally absorbs radiolabeled peptides used in PRRT, causing radiation damage to blood cells produced there. When the spleen has been removed (splenectomy), this radiation sink is eliminated, resulting in much less blood cell damage—12.8% vs 47.2% leukocyte decline at 24 months.

Could this mean more treatment for some patients?

Yes. PRRT is often limited to 4 cycles because of blood cell toxicity. Splenectomized patients—who often have pancreatic NETs with worse prognosis—may safely receive additional cycles or reinduction therapy, potentially improving their outcomes.

Read the original research

Multicentric Matched-Pair Analysis of Long-Term Hematotoxicity of Peptide Receptor Radionuclide Therapy in Patients Postsplenectomy.

Journal of nuclear medicine : official publication, Society of Nuclear Medicine, 66(12), 1934-1940

View on PubMed ↗Publisher’s paper ↗

Citation

Steinhelfer, Lisa; Jungmann, Friederike; Endroes, Lukas; Lanzafame, Helena; Hermann, Ken; Pfob, Christian H; Lapa, Constantin; Hartrampf, Philipp E; Dörrler, Anna-Lena; Buck, Andreas K; Götze, Katharina; Wenzel, Patrick; Geisler, Fabian; Walter, Robert; Haneder, Eva; Lohöfer, Fabian; Haller, Bernhard; Braren, Rickmer; Eiber, Matthias. (2025). Multicentric Matched-Pair Analysis of Long-Term Hematotoxicity of Peptide Receptor Radionuclide Therapy in Patients Postsplenectomy.. Journal of nuclear medicine : official publication, Society of Nuclear Medicine, 66(12), 1934-1940. https://doi.org/10.2967/jnumed.125.270190