The Impact of Splenectomy in Myelofibrosis Patients before Allogeneic Hematopoietic Stem Cell Transplantation

Abstract

Performing a pretransplantation splenectomy in patients with myelofibrosis (MF) is a matter of debate, as while the procedure improves hematological recovery, it may lead to severe morbidities. We retrospectively analyzed data from 85 consecutive patients who underwent transplantation in our center for MF, including 39 patients who underwent splenectomy before their transplantation. A majority of them had primary MF (78%), were considered high-risk patients (84% dynamic international prognostic scoring system intermediate-2 or higher), and had received transplants from HLA-matched sibling donors (56%) after a reduced-intensity conditioning regimen (82%). One-half of all splenectomized patients presented surgical or postsurgical morbidities, most frequently thrombosis and hemorrhage. After adjustment using Cox models, pretransplantation splenectomy was not associated with nonrelapse mortality or post-transplantation relapse but with an improved overall survival (OS) and event-free survival (EFS). We conclude that some patients with huge splenomegaly may undergo pretransplantation splenectomy without a deleterious impact on post-transplantation outcomes. OS and EFS improvement should in confirmed in controlled study.

Impact of ruxolitinib pretreatment on outcomes after allogeneic stem cell transplantation in patients with myelofibrosis

“…18,19,26 Measures to reduce spleen size such splenectomy and splenic irradiation have been employed prior to ASCT to reduce its negative effect on ASCT outcome. [27][28][29] However, splenectomy is generally not preferred due to its perioperative complication risk (infection, thrombosis, bleeding) including a 5 to 10 percent mortality rate. 14,30 Akpek et al reviewed the effect of spleen size in early outcomes of stem cell transplantation.…”

Risk factors and a prognostic model for postsplenectomy survival in myelofibrosis

“…Splenectomy is also sometimes considered as a preparative measure before ASCT, to improve post‐transplant recovery of counts. Published reports in this regard have not been definitive, regarding the advisability of such practice, but agree on its value in terms of faster platelet and granulocyte recovery; these studies have also indicated the lack of detrimental effect on the risk of disease relapse or nonrelapse mortality and morbidity. What is not currently clear is whether or not pretransplant splenectomy in MF results in superior or inferior post‐transplant survival.…”

Reduced‐intensity conditioning allogeneic transplant with dual T‐cell depletion in myelofibrosis

“…The molecular and cytogenetic profile at diagnosis should be considered in order to better determine the optimal timing for transplant and post-transplant outcome. [32][33][34][35][36][37][38][39][40][41][42][43][44][45][46] MIPSS70+ v2.0 should be assessed prior to allo-HSCT because it has been found to be predictive for long-term survival in MF patients after allo-HSCT. 32 In conclusion, the use of RIC allo-HSCT combined with ATG and PTCy results in promising 1-year OS and RFS in patients with MF mainly using MRD and 10/10 MUD grafts.…”