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Clinical Trial
. 2013 Jun;48(6):825-31.
doi: 10.1038/bmt.2012.249. Epub 2012 Dec 10.

Effects of spleen status on early outcomes after hematopoietic cell transplantation

G Akpek  1 , M C Pasquini, B Logan, M-A Agovi, H M Lazarus, D I Marks, M Bornhaeüser, O Ringdén, R T Maziarz, V Gupta, U Popat, D Maharaj, B J Bolwell, J D Rizzo, K K Ballen, K R Cooke, P L McCarthy, V T Ho
Affiliations
Clinical Trial

Effects of spleen status on early outcomes after hematopoietic cell transplantation

G Akpek et al. Bone Marrow Transplant. 2013 Jun.

Abstract

To assess the impact of spleen status on engraftment, and early morbidity and mortality after allogeneic hematopoietic cell transplantation (HCT), we analyzed 9,683 myeloablative allograft recipients from 1990 to 2006; 472 had prior splenectomy (SP), 300 splenic irradiation (SI), 1,471 with splenomegaly (SM), and 7,440 with normal spleen (NS). Median times to neutrophil engraftment (NE) and platelet engraftment (PE) were 15 vs 18 days and 22 vs 24 days for the SP and NS groups, respectively (P<0.001). Hematopoietic recovery at day +100 was not different across all groups, however the odds ratio of days +14 and +21 NE and day +28 PE were 3.26, 2.25 and 1.28 for SP, and 0.56, 0.55, and 0.82 for SM groups compared to NS (P<0.001), respectively. Among patients with SM, use of peripheral blood grafts improved NE at day +21, and CD34+ cell dose >5.7 × 10(6)/kg improved PE at day+28. After adjusting variables by Cox regression, the incidence of GVHD and OS were not different among groups. SM is associated with delayed engraftment, whereas SP prior to HCT facilitates early engraftment without having an impact on survival.

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Conflict of interest statement

No conflict of interest relevant to this manuscript to report.

Figures

Figure 1
Figure 1
Cumulative incidence of neutrophil engraftment by spleen status Abbreviations: NS, normal spleen; SI, splenic irradiation; SM, splenomegaly; SP, splenectomy.
Figure 2
Figure 2
A: Box plots of odds for neutrophil engraftment at 14, 21 and 28 days post-transplant by spleen status compared to normal spleen. B: Box plots of odds for platelet engraftment at 28 and 60 days post-transplant by spleen status compared to normal spleen. Abbreviations: NS, normal spleen; SI, splenic irradiation; SM, splenomegaly; SP, splenectomy.
Figure 2
Figure 2
A: Box plots of odds for neutrophil engraftment at 14, 21 and 28 days post-transplant by spleen status compared to normal spleen. B: Box plots of odds for platelet engraftment at 28 and 60 days post-transplant by spleen status compared to normal spleen. Abbreviations: NS, normal spleen; SI, splenic irradiation; SM, splenomegaly; SP, splenectomy.
Figure 3
Figure 3
Adjusted overall survival by spleen status Abbreviations: NS, normal spleen; SI, splenic irradiation; SM, splenomegaly; SP, splenectomy.
See this image and copyright information in PMC

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