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)

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‐b...

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Published inAmerican journal of hematology Vol. 96; no. 1; pp. 69 - 79
Main Authors Polverelli, Nicola, Mauff, Katya, Kröger, Nicolaus, Robin, Marie, Beelen, Dietrich, Beauvais, David, Chevallier, Patrice, Mohty, Mohamad, Passweg, Jakob, Rubio, Marie Thérèse, Maertens, Johan, Finke, Jürgen, Bornhäuser, Martin, Vrhovac, Radovan, Helbig, Grzegorz, Mear, Jean‐Baptiste, Castagna, Luca, Reményi, Péter, Angelucci, Emanuele, Karakasis, Dimitrios, Rifòn, Jose, Sirait, Tiarlan, Russo, Domenico, Wreede, Liesbeth, Czerw, Tomasz, Hernández‐Boluda, Juan Carlos, Hayden, Patrick, McLornan, Donal, Yakoub‐Agha, Ibrahim
Format Journal Article
LanguageEnglish
Published Hoboken, USA John Wiley & Sons, Inc 01.01.2021
Wiley Subscription Services, Inc
Wiley
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ISSN0361-8609
1096-8652
1096-8652
DOI10.1002/ajh.26020

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Summary: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.
Bibliography:Nicola Polverelli and Katya Mauff have contributed equally. Donal McLornan and Ibrahim Yakoub‐Agha have senior joint authorship.
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ISSN:0361-8609
1096-8652
1096-8652
DOI:10.1002/ajh.26020