title: 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.
authors.affiliation: Hematology-Transplantation Department, Hôpital Saint-Louis, APHP, University Paris VII, INSERM UMR1160, Paris, France. Electronic address: marie.robin@aphp.fr.
authors.forename: Marie
authors.initials: M
authors.lastname: Robin
authors.affiliation: Hematology-Transplantation Department, Hôpital Saint-Louis, APHP, University Paris VII, INSERM UMR1160, Paris, France.
authors.forename: Maryem
authors.initials: M
authors.lastname: Zine
authors.affiliation: Biostatistics Department, Hôpital Saint-Louis, APHP, University Paris VII, Paris, France.
authors.forename: Sylvie
authors.initials: S
authors.lastname: Chevret
authors.affiliation: Department of Pathology, Hôpital Saint-Louis, APHP, University Paris VII, Paris, France.
authors.forename: Véronique
authors.initials: V
authors.lastname: Meignin
authors.affiliation: Department of General, Digestive and Endocrine Surgery, Hôpital Saint-Louis, APHP, University Paris VII, Paris, France.
authors.forename: Nicolas
authors.initials: N
authors.lastname: Munoz-Bongrand
authors.affiliation: Hematology-Transplantation Department, Hôpital Saint-Louis, APHP, University Paris VII, INSERM UMR1160, Paris, France.
authors.forename: Hannah
authors.initials: H
authors.lastname: Moatti
authors.affiliation: Hematology-Transplantation Department, Hôpital Saint-Louis, APHP, University Paris VII, INSERM UMR1160, Paris, France.
authors.forename: Aliénor
authors.initials: A
authors.lastname: Xhaard
authors.affiliation: Hematology-Transplantation Department, Hôpital Saint-Louis, APHP, University Paris VII, INSERM UMR1160, Paris, France.
authors.forename: Flore
authors.initials: F
authors.lastname: Sicre de Fontbrune
authors.affiliation: Hematology-Transplantation Department, Hôpital Saint-Louis, APHP, University Paris VII, INSERM UMR1160, Paris, France.
authors.forename: Régis
authors.initials: R
authors.lastname: Peffault de Latour
authors.affiliation: Department of General, Digestive and Endocrine Surgery, Hôpital Saint-Louis, APHP, University Paris VII, Paris, France.
authors.forename: Emile
authors.initials: E
authors.lastname: Sarfati
authors.affiliation: Hematology-Transplantation Department, Hôpital Saint-Louis, APHP, University Paris VII, INSERM UMR1160, Paris, France.
authors.forename: Gérard
authors.initials: G
authors.lastname: Socié
mesh_terms: D000328:Adult; D005260:Female; D018380:Hematopoietic Stem Cell Transplantation / Q000379:methods*; D006470:Hemorrhage / Q000209:etiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D055728:Primary Myelofibrosis / Q000401:mortality / Q000601:surgery* / Q000628:therapy; D012189:Retrospective Studies; D035781:Siblings; D013156:Splenectomy / Q000009:adverse effects* / Q000401:mortality; D013163:Splenomegaly / Q000601:surgery; D016019:Survival Analysis; D013927:Thrombosis / Q000209:etiology; D014184:Transplantation, Homologous; D016896:Treatment Outcome
keywords: Allogeneic transplantation; Myelofibrosis; Myeloproliferative neoplasia; Splenectomy; Splenomegaly