Splenic rupture in a patient with acute myeloid leukemia undergoing peripheral blood stem cell transplantation

Abstract

Splenic rupture is a rare but well-recognized complication of hematological malignancies. Here, we present the case of a 22-year-old woman with the diagnosis of acute myeloid leukemia who was undergoing peripheral blood stem cell transplantation. On day + 10 she developed a hypovolemic shock due to rupture of her spleen and went to emergency laparotomy. This is the first report of splenic rupture during peripheral blood stem cell transplantation.

Splenic rupture in a patient with plasma cell myeloma following G-CSF/GM-CSF administration for stem cell transplantation and review of the literature

“…4,7,11 However, this does not explain the cause of rupture in healthy donors. A probable cause or risk factor of rupture is not apparent from studying a limited number of cases or from the data available.…”

“…16 The splenomegaly has been attributed to infiltration of the red pulp by granulocytes in some cases as well as the presence of extramedullary hematopoiesis in others. Although splenomegaly seems to be a common side effect, there are only occasional cases of splenic rupture reported and we have attempted to identify all cases of splenic rupture related to G-CSF/GM-CSF therapy reported in the English literature (Table 1) [2][3][4][5][6][7][8][9][10][11][12][13] with an additional case from our institution. Recently, a similar study was published by Nuamah et al, 12 but it does not include all published cases.…”

“…As noted in Table 1, there is a broad range of underlying disorders with most being hematologic. [2][3][4][5][6][7][8][9][10][11][12][13] The splenic rupture occurred not only in patients with underlying hematopoietic disorders, but also in patients with solid tumors and healthy donors. Most patients experienced malaise, pain radiating to the left shoulder, drop in blood pressure and decrease in hematocrit.…”

“…The salient features of all cases with splenic rupture involving G-CSF/GM-CSF treatment that have been reported in the English literature are summarized in Table 1. [2][3][4][5][6][7][8][9][10][11][12][13] The cases include individuals receiving G-CSF/GM-CSF for neutropenia, patients being prepared for autologous stem cell transplant and donors undergoing PBPC mobilization. Of note is the fact that spontaneous splenic ruptures occurred not only in diseased patients, but also in healthy donors.…”

Spontaneous rupture of the spleen in AL amyloidosis

“…However, in the other case splenic rupture occurred on the sixth day of administration of G-CSF (at 16 mcg/kg/day) without evidence of any underlying disorder of the spleen or of a coagulation abnormality or trauma. In addition, Kasper et al [41] have reported a patient with acute myeloid leukemia, in remission, undergoing autologous peripheral blood stem cell transplantation who developed splenic rupture while on G-CSF injections (at 5 mcg/kg/day) during the peritransplant period prior to hematopoietic recovery.…”