Hydroxyurea is a useful, oral, well-tolerated, nonspecific myelosuppressive agent that can reduce the leuko-cytosis and occasional thrombocytosis associated with MMM.77 The reduction of leukocytosis in MMM is clinically useful only if it is extreme and symptomatic, or if the reduction in leukocytosis leads to a significant reduction in splenomegaly (seen in approximately 25% of patients). Occasionally, substantial doses of hydroxyurea (2-3 g/day) are needed to achieve a meaningful reduction in splenomegaly. Hydroxyurea may potentially exacerbate anemia or thrombocytopenia (if present), but supplemental exogenous erythropoietin may

Table 49.3 Reports of therapeutic splenectomy in CIMF/MMM




Number of patients

Mortality (%)


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