title: Improved Splenic Function After Hematopoietic Stem Cell Transplant for Sickle Cell Disease.
abstract: BACKGROUND
  Splenic dysfunction is a significant complication of sickle cell disease (SCD). Hematopoietic stem cell transplant (HSCT) is a proven cure for SCD; however, its long-term effect on splenic function is not well characterized.
  
  
  METHODS
  We conducted a retrospective cohort study of pediatric patients who had HSCT for SCD at two transplant centers. (99m) Tc liver-spleen (LS) scans were blindly reviewed and classified as demonstrating absent, decreased, or normal splenic uptake.
  
  
  RESULTS
  Considering all engrafted nonsplenectomized Hb SS and Sβ(0) -thalassemia patients with LS scans available, at a median of 2.0 years post-HSCT (range 1.0-9.3 years) eight of 53 (15%) had normal, 40 of 53 (75%) decreased, and five of 53 (9%) absent splenic uptake. More patients had splenic uptake after HSCT: pre-HSCT 14/38 (37%) versus post-HSCT 34/38 (89%), P < 0.0001. Older age at HSCT was associated with worse splenic function post-HSCT (median age at HSCT for absent uptake 16.6 years vs. present uptake 8.0 years, P = 0.030). Extensive chronic GVHD was also more common in patients with absent splenic uptake compared to patients with present uptake (absent 40% vs. present 6%, P = 0.064).
  
  
  CONCLUSIONS
  HSCT significantly improves splenic function for most pediatric patients with SCD, but older patient age at time of HSCT and extensive chronic GVHD appear to be risk factors for poor post-HSCT splenic function.
authors.affiliation: Division of Hematology, Children's National Health System, Washington, District of Columbia.
authors.forename: Robert Sheppard
authors.initials: RS
authors.lastname: Nickel
authors.affiliation: Division of Pediatric Hematology, Oncology and Stem Cell Transplantation, Morgan Stanley Children's Hospital of New York Presbyterian, Columbia University Medical Center, New York, New York.
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Seashore
authors.affiliation: Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta, Emory University, Atlanta, Georgia.
authors.forename: Peter A
authors.initials: PA
authors.lastname: Lane
authors.affiliation: Department of Radiology and Imaging Sciences, Emory University, Atlanta, Georgia.
authors.forename: Adina L
authors.initials: AL
authors.lastname: Alazraki
authors.affiliation: Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta, Emory University, Atlanta, Georgia.
authors.forename: John T
authors.initials: JT
authors.lastname: Horan
authors.affiliation: Division of Pediatric Hematology, Oncology and Stem Cell Transplantation, Morgan Stanley Children's Hospital of New York Presbyterian, Columbia University Medical Center, New York, New York.
authors.forename: Monica
authors.initials: M
authors.lastname: Bhatia
authors.affiliation: Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta, Emory University, Atlanta, Georgia.
authors.forename: Ann E
authors.initials: AE
authors.lastname: Haight
mesh_terms: D000293:Adolescent; D000367:Age Factors; D064591:Allografts; D000755:Anemia, Sickle Cell / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000628:therapy; D002648:Child; D002675:Child, Preschool; D005260:Female; D005500:Follow-Up Studies; D018380:Hematopoietic Stem Cell Transplantation; D006801:Humans; D007223:Infant; D008099:Liver / Q000000981:diagnostic imaging / Q000503:physiopathology; D008297:Male; D011877:Radionuclide Imaging; D020127:Recovery of Function; D012189:Retrospective Studies; D013154:Spleen / Q000000981:diagnostic imaging / Q000503:physiopathology
keywords: sickle cell disease; spleen; splenic function; stem cell transplant