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)
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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, 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; de Wreede, Liesbeth; Czerw, Tomasz; Hernández-Boluda, Juan Carlos; Hayden, Patrick; McLornan, Donal; Yakoub-Agha, Ibrahim.
in: AM J HEMATOL, Jahrgang 96, Nr. 1, 01.2021, S. 69-79.Publikationen: SCORING: Beitrag in Fachzeitschrift/Zeitung › SCORING: Zeitschriftenaufsatz › Forschung › Begutachtung
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TY - JOUR
T1 - 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)
AU - Polverelli, Nicola
AU - Mauff, Katya
AU - Kröger, Nicolaus
AU - Robin, Marie
AU - Beelen, Dietrich
AU - Beauvais, David
AU - Chevallier, Patrice
AU - Mohty, Mohamad
AU - Passweg, Jakob
AU - Rubio, Marie Thérèse
AU - Maertens, Johan
AU - Finke, Jürgen
AU - Bornhäuser, Martin
AU - Vrhovac, Radovan
AU - Helbig, Grzegorz
AU - Mear, Jean-Baptiste
AU - Castagna, Luca
AU - Reményi, Péter
AU - Angelucci, Emanuele
AU - Karakasis, Dimitrios
AU - Rifòn, Jose
AU - Sirait, Tiarlan
AU - Russo, Domenico
AU - de Wreede, Liesbeth
AU - Czerw, Tomasz
AU - Hernández-Boluda, Juan Carlos
AU - Hayden, Patrick
AU - McLornan, Donal
AU - Yakoub-Agha, Ibrahim
N1 - © 2020 Wiley Periodicals LLC.
PY - 2021/1
Y1 - 2021/1
N2 - 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.
AB - 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.
KW - Allografts
KW - Antineoplastic Combined Chemotherapy Protocols/administration & dosage
KW - Busulfan/administration & dosage
KW - Disease-Free Survival
KW - Female
KW - Follow-Up Studies
KW - Hematopoietic Stem Cell Transplantation
KW - Humans
KW - Male
KW - Melphalan/administration & dosage
KW - Middle Aged
KW - Organ Size
KW - Primary Myelofibrosis/mortality
KW - Registries
KW - Retrospective Studies
KW - Spleen/pathology
KW - Splenectomy
KW - Survival Rate
KW - Vidarabine/administration & dosage
U2 - 10.1002/ajh.26020
DO - 10.1002/ajh.26020
M3 - SCORING: Journal article
C2 - 33064301
VL - 96
SP - 69
EP - 79
JO - AM J HEMATOL
JF - AM J HEMATOL
SN - 0361-8609
IS - 1
ER -
