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).
Journal article

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 N Unit of Blood Diseases and Stem Cells Transplantation, Department of Clinical and Experimental Sciences, University of Brescia, ASST Spedali Civili of Brescia.
  • Mauff K Leiden Data Office, LUMC, Leiden, Netherlands.
  • Kröger N Department of Hematology, University Hospital Eppendorf, Hamburg, Germany.
  • Robin M Department of Hematology, Hôpital Saint-Louis, APHP, Paris, France.
  • Beelen D Department of Hematology, University Hospital of Essen, Essen, Germany.
  • Beauvais D Department of Hematology, CHU Lille, Lille, France.
  • Chevallier P Department of Hematology, CHU Nantes, Nantes, France.
  • Mohty M Sorbonne University, Paris, France.
  • Passweg J Department of Hematology, University Hospital Basel, Basel, Switzerland.
  • Rubio MT Department of Hematology, CHRU BRABOIS, Vandoeuvre Les Nancy, France.
  • Maertens J Department of Hematology, University Hospital Gasthuisberg, Leuven, Belgium.
  • Finke J Department of Hematology, University of Freiburg, Freiburg, Germany.
  • Bornhäuser M Department of Hematology, University Hospital Dresded, Dresden, Germany.
  • Vrhovac R Department of Hematology, University Hospital Center Rebro, Zagreb, Croatia.
  • Helbig G Department of Hematology, Silesian Medical Academy, Katowice, Poland.
  • Mear JB Department of Hematology, Centre Hospitalier Universitaire de Rennes, Rennes, France.
  • Castagna L Department of Hematology, Centre de Recherche en Cancérologie de Marseille, Marseille, France.
  • Reményi P Department of Hematology, Dél-pesti Centrumkórház, Budapest, Hungary.
  • Angelucci E Hematology and Transplant Center, IRCCS Ospedale Policlinico San Martino, Genoa, Italy.
  • Karakasis D Department of Hematology, Evangelismos Hospital, Athens, Greece.
  • Rifòn J Department of Hematology, Clínica Universitaria de Navarra, Pamplona, Spain.
  • Sirait T Leiden Data Office, LUMC, Leiden, Netherlands.
  • Russo D Unit of Blood Diseases and Stem Cells Transplantation, Department of Clinical and Experimental Sciences, University of Brescia, ASST Spedali Civili of Brescia.
  • de Wreede L Department of Biomedical Data Sciences, LUMC, Leiden, Netherlands.
  • Czerw T Department of Bone Marrow Transplantation and Onco-Hematology, Maria Sklodowska-Curie National Research Institute of Oncology, Gliwice, Poland.
  • Hernández-Boluda JC Department of Hematology, Hospital Clínico Universitario de Valencia, Valencia, Spain.
  • Hayden P Department of Hematology, St. James's Hospital, Dublin, Ireland.
  • McLornan D Department of Hematology, Guy's and St Thomas' NHS Foundation Trust and University College London Hospitals, London, UK.
  • Yakoub-Agha I CHU de Lille, Université de Lille, Lille, France.
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  • 2020-10-16
Published in:
  • American journal of hematology. - 2020
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.
Language
  • English
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closed
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https://sonar.ch/global/documents/231575
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