Effects of Splenectomy before Transplantation on β-Thalassaemia Major with Matched Sibling and Unrelated Hematopoietic Stem Cell Transplantation

Abstract

Purpose:Splenectomy can improve the quality of life of patients with β-thalassaemia major to some extent, but also increase some unpredictable risk.In order to understand the effects of splenectomy before transplantation on hematopoietic stem cell transplantation reconstruction time, infection, graft versus host disease and hepatic veno-occlusive disease of matched sibling and unrelated hematopoietic stem cell transplantation, the following studies were conducted. Methods:A retrospective analysis of 80 β-thalassaemia major patients in the southern hospital between January 2012 and December 2017 for matched hematopoietic stem cell transplantation, and 35 of them had a splenectomy before the transplant. Cox model adjustment, t test and χ2 test were used to compare the incidence of neutrophil implantation time, hemoglobin implantation time, platelet implantation time, infection, graft versus host disease and hepatic vein occlusion. Results:Neutrophilic granulocytes and platelets were implanted more rapidly in patients who underwent splenectomy than those who did not (P < 0.05).There was no significant difference in the incidence of infection, graft versus host disease and hepatic vein occlusion. Conclusion: For level of Ⅱ-Ⅲ β-thalassaemia major patients, hypersplenism can cause delayed reconstruction of hematopoietic stem cell transplantation, while before transplantation splenectomy to speed up the implantation of hematopoietic stem cell transplantation, and does not increase the incidence of complications after transplantation. Disclosures No relevant conflicts of interest to declare.

Impact of splenectomy on outcomes of hematopoietic stem cell transplantation in pediatric patients with transfusion‐dependent thalassemia

“…Noticeable, the proportion of late deaths was more in the splenectomized group (50%) than in the nonsplenectomized group (14.3%), and encapsulated bacterial sepsis was one of the causes of late death in splenectomized patients in our study. There was no significant impact of splenectomies on the incidences of acute or chronic GvHD, or of VOD, which was consistent with other reports on β‐thalassemia major 5,8 . We also did not observe any long‐term complications, such as thrombosis or restrictive pulmonary function, among the splenectomized patients in our study, which corresponded with the findings of the previous study 5 .…”

“…Our splenectomized patients had significantly faster neutrophil engraftments, despite their numbers of CD34 + and TMN cells not being significantly different from those for the nonsplenectomized patients. This observation is consistent with earlier studies of β‐thalassemia major, Gaucher's disease, myelofibrosis, and chronic myeloid leukemia patients, which demonstrated that a splenectomy before an HSCT could alter engraftment kinetics and enhance neutrophil engraftment 5‐8,14‐17 . However, and in contrast to a previous report on β‐thalassemia major, 5,7 our study found that the time to red blood cell transfusion independence, platelet engraftments, and transfusion requirements during transplant period were not significantly different.…”

“…However, only a few studies have reported the impact of pretransplant splenectomies on patients with β‐thalassemia major undergoing an allogeneic HSCT. The results showed that the splenectomies were associated with faster engraftment and reduced transfusion support but the benefit of pre‐HSCT splenectomy in outcome is still controversial 5,7,8 . Since splenomegaly is still prevalent in Thai TDT patients, we were interested in analyzing our HSCT cohort to address the effects of pretransplant splenectomy on the outcomes of children with TDT undergoing matched‐related HSCTs and provide a recommendation for future patients.…”