Impact of spleen size and splenectomy on outcomes of allogeneic hematopoietic cell transplantation for myelofibrosis: A retrospective analysis by the chronic malignancies working party on behalf of European society for blood and marrow transplantation (EBMT).
Polverelli NUnit of Blood Diseases and Stem Cells Transplantation, Department of Clinical and Experimental Sciences, University of Brescia, ASST Spedali Civili of Brescia.
Mauff KLeiden Data Office, LUMC, Leiden, Netherlands.
Kröger NDepartment of Hematology, University Hospital Eppendorf, Hamburg, Germany.
Robin MDepartment of Hematology, Hôpital Saint-Louis, APHP, Paris, France.
Beelen DDepartment of Hematology, University Hospital of Essen, Essen, Germany.
Beauvais DDepartment of Hematology, CHU Lille, Lille, France.
Chevallier PDepartment of Hematology, CHU Nantes, Nantes, France.
Passweg JDepartment of Hematology, University Hospital Basel, Basel, Switzerland.
Rubio MTDepartment of Hematology, CHRU BRABOIS, Vandoeuvre Les Nancy, France.
Maertens JDepartment of Hematology, University Hospital Gasthuisberg, Leuven, Belgium.
Finke JDepartment of Hematology, University of Freiburg, Freiburg, Germany.
Bornhäuser MDepartment of Hematology, University Hospital Dresded, Dresden, Germany.
Vrhovac RDepartment of Hematology, University Hospital Center Rebro, Zagreb, Croatia.
Helbig GDepartment of Hematology, Silesian Medical Academy, Katowice, Poland.
Mear JBDepartment of Hematology, Centre Hospitalier Universitaire de Rennes, Rennes, France.
Castagna LDepartment of Hematology, Centre de Recherche en Cancérologie de Marseille, Marseille, France.
Reményi PDepartment of Hematology, Dél-pesti Centrumkórház, Budapest, Hungary.
Angelucci EHematology and Transplant Center, IRCCS Ospedale Policlinico San Martino, Genoa, Italy.
Karakasis DDepartment of Hematology, Evangelismos Hospital, Athens, Greece.
Rifòn JDepartment of Hematology, Clínica Universitaria de Navarra, Pamplona, Spain.
Sirait TLeiden Data Office, LUMC, Leiden, Netherlands.
Russo DUnit of Blood Diseases and Stem Cells Transplantation, Department of Clinical and Experimental Sciences, University of Brescia, ASST Spedali Civili of Brescia.
de Wreede LDepartment of Biomedical Data Sciences, LUMC, Leiden, Netherlands.
Czerw TDepartment of Bone Marrow Transplantation and Onco-Hematology, Maria Sklodowska-Curie National Research Institute of Oncology, Gliwice, Poland.
Hernández-Boluda JCDepartment of Hematology, Hospital Clínico Universitario de Valencia, Valencia, Spain.
Hayden PDepartment of Hematology, St. James's Hospital, Dublin, Ireland.
McLornan DDepartment of Hematology, Guy's and St Thomas' NHS Foundation Trust and University College London Hospitals, London, UK.
Yakoub-Agha ICHU de Lille, Université de Lille, Lille, France.
English
The role of spleen size and splenectomy for the prediction of post-allogeneic hematopoietic stem cell transplant (allo-HCT) outcome in myelofibrosis remains under debate. In EBMT registry, we identified a cohort of 1195 myelofibrosis patients transplanted between 2000-2017 after either fludarabine-busulfan or fludarabine-melphalan regimens. Overall, splenectomy was performed in 202 (16.9%) patients and its use decreased over time (28.3% in 2000-2009 vs 14.1% in 2010-2017 period). By multivariate analysis, splenectomy was associated with less NRM (HR 0.64, 95% CI 0.44-0.93, P = .018) but increased risk of relapse (HR 1.43, 95% CI 1.01-2.02, P = .042), with no significant impact on OS (HR 0.86, 95% CI 0.67-1.12, P = .274). However, in subset analysis comparing the impact of splenectomy vs specific spleen sizes, for patients with progressive disease, an improved survival was seen in splenectomised subjects compared to those patients with a palpable spleen length ≥ 15 cm (HR 0.44, 95% CI 0.28-0.69, P < .001), caused by a significant reduction in NRM (HR 0.26, 95% CI 0.14-0.49, P < .001), without significantly increased relapse risk (HR 1.47, 95% CI 0.87-2.49, P = .147). Overall, despite the possible biases typical of retrospective cohorts, this study highlights the potential detrimental effect of massive splenomegaly in transplant outcome and supports the role of splenectomy for myelofibrosis patients with progressive disease and large splenomegaly.