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Pros and cons of splenectomy in patients with myelofibrosis undergoing stem cell transplantation

Leukemia volume 15, pages 465–467 (2001)Cite this article

Abstract

During fetal development, the spleen is a major hemopoietic organ. In the adult human, this task is relinquished to the bone marrow. However, under the stress of certain pathologic conditions, extramedullary hemopoiesis may again occur in the spleen. This is especially true for diseases of the marrow, in particular, myeloproliferative disorders such as agnogenic myeloid metaplasia, which is associated with severe fibrosis of the marrow space. At the same time, the spleen sequesters blood cells and contributes to peripheral blood cytopenias, which may improve following splenectomy. However, success is unpredictable, and the operative mortality of splenectomy is on the order of 10%. As a growing number of patients undergo hemopoietic stem cell transplantation as definitive therapy for myelofibrosis, the decision on splenectomy has additional ramifications since the spleen plays an important role in the kinetics of engraftment of donor cells and in immune reconstitution. We conclude from our analysis of available information that the benefit of splenectomy is difficult to predict, although after transplantation splenectomized patients have faster hemopoietic recovery. It appears that the most important indication for splenectomy in these patients is the relief of symptoms from massive spleen enlargement.

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References

  1. Tefferi A . Myelofibrosis with myeloid metaplasia (review) N Engl J Med 2000 342: 1255–1265

    Article  CAS  Google Scholar 

  2. Tefferi A, Messa RA, Nagorney DM, Schroeder G, Silverstein MN . Splenectomy in myelofibrosis with myeloid metaplasia: a single-institution experience with 223 patients Blood 2000 95: 2226–2233

    CAS  PubMed  Google Scholar 

  3. Benbassat J . Myelofibrosis with myeloid metaplasia N Engl J Med 2000 343: 659

    Article  CAS  Google Scholar 

  4. Barosi G, Ambrosetti A, Centra A, Falcone A, Finelli C, Foa P, Grossi A, Guarnone R, Rupoli S, Luciano L, Petti MC, Pogliani E, Russo D, Ruggeri M, Quaglini S . Splenectomy and risk of blast transformation in myelofibrosis with myeloid metaplasia Blood 1998 91: 3630–3636

    CAS  PubMed  Google Scholar 

  5. Elliott MA, Chen MG, Silverstein MN, Tefferi A . Splenic irradiation for symptomatic splenomegaly associated with myelofibrosis with myeloid metaplasia Br J Haematol 1998 103: 505–511

    Article  CAS  Google Scholar 

  6. Brenner B, Nagler A, Tatarsky I, Hashmonai M . Splenectomy in agnogenic myeloid metaplasia and postpolycythemic myeloid metaplasia. A study of 34 cases Arch Intern Med 1988 148: 2501–2505

    Article  CAS  Google Scholar 

  7. Coon WW, Liepman MK . Splenectomy for agnogenic myeloid metaplasia Surg Gynecol Obstet 1982 154: 561–563

    CAS  PubMed  Google Scholar 

  8. Guardiola P, Anderson JE, Bandini G, Cervantes F, Runde V, Arcese W, Bacigalupo A, Przepiorka D, O'Donnell MR, Polchi P, Buzyn A, Sutton L, Cazals-Hatem D, Sale G, De Witte T, Deeg HJ, Gluckman E, for the International Collaboration for Transplantation in Agnogenic Myeloid Metaplasia . Allogeneic stem cell transplantation for agnogenic myeloid metaplasia: a European Group for Blood and Marrow Transplantation, Société Française de Greffe de Moelle, Gruppo Italiano per il Trapianto del Midollo Osseo, and Fred Hutchinson Cancer Research Center collaborative study Blood 1999 93: 2831–2838

    CAS  PubMed  Google Scholar 

  9. Li Z, Gooley T, Appelbaum FR, Deeg HJ . Splenectomy and hemopoietic stem cell transplantation for myelofibrosis (letter) Blood (in press)

  10. Martino R, Altes A, Muniz-Diaz E, Brunet S, Sureda A, Domingo-Albos A, Madoz P . Reduced transfusion requirements in a splenectomized patient undergoing bone marrow transplantation Acta Haematol 1994 92: 167–168

    Article  CAS  Google Scholar 

  11. von Bueltzingsloewen A, Bordigoni P, Dorvaux Y, Witz F, Schmitt C, Chastagner P, Sommelet D . Splenectomy may reverse pancytopenia occurring after allogeneic bone marrow transplantation (letter) Bone Marrow Transplant 1994 14: 339–340

    CAS  PubMed  Google Scholar 

  12. Brown AR . Immunological functions of splenic B-lymphocytes (review) Crit Rev Immunol 1992 11: 395–417

    CAS  PubMed  Google Scholar 

  13. Liu YJ . Sites of B lymphocyte selection, activation, and tolerance in spleen (review) J Exp Med 1997 186: 625–629

    Article  CAS  Google Scholar 

  14. Ringden O, Nilsson B . Death by graft-versus-host disease associated with HLA mismatch, high recipient age, low marrow cell dose, and splenectomy Transplantation 1985 40: 39–44

    Article  CAS  Google Scholar 

  15. Michallet M, Corront B, Bosson JL, Molina L, Peissel B, Maraninchi D, Reiffers J, Chabannon C, Gaspard MH, Stoppa AM, Blaise D, Marit G, Hollard D, Carcassone Y, Broustet A, Demongeot J . Role of splenectomy in incidence and severity of acute graft-versus-host disease: a multicenter study of 157 patients Bone Marrow Transplant 1991 8: 13–17

    CAS  PubMed  Google Scholar 

  16. Boström L, Ringdén O, Jacobsen N, Zwaan F, Nilsson B . A European multicenter study of chronic graft-versus-host disease. The role of cytomegalovirus serology in recipients and donors, acute graft-versus-host disease, and splenectomy Transplantation 1990 49: 1100–1105

    Article  Google Scholar 

  17. Kalhs P, Schwarzinger I, Anderson G, Mori M, Clift RA, Storb R, Buckner CD, Appelbaum FR, Hansen JA, Sullivan KM . A retrospective analysis of the long-term effect of splenectomy on late infections, graft-versus-host disease, relapse, and survival after allogeneic marrow transplantation for chronic myelogenous leukemia Blood 1995 86: 2028–2032

    CAS  PubMed  Google Scholar 

  18. Tollemar J, Ringden O, Bostrom L, Nilsson B, Sundberg B . Variables predicting deep fungal infections in bone marrow transplant recipients Bone Marrow Transplant 1989 4: 635–641

    CAS  PubMed  Google Scholar 

  19. Jarvinen H, Kivilaakso E, Ikkala E, Vuopio P, Hastbacka J . Splenectomy for myelofibrosis Ann Clin Res 1982 14: 66–71

    CAS  PubMed  Google Scholar 

Download references

Acknowledgements

This study was supported in part by PHS grants HL36444, CA18029, and CA87948. HJD is also supported by a grant from the Gabrielle Rich Leukemia Fund. We thank H Crawford and B Larson for help with manuscript preparation. The current address of ZL is Center for Immunotherapy, MC 1601, University of Connecticut Health Center, Farmington, CT 06030-1601.

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  1. Fred Hutchinson Cancer Research Center and the University of Washington, Seattle, WA, USA

    Z Li & HJ Deeg

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Li, Z., Deeg, H. Pros and cons of splenectomy in patients with myelofibrosis undergoing stem cell transplantation. Leukemia 15, 465–467 (2001). https://doi.org/10.1038/sj.leu.2402043

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