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Splenectomy as a measure to treat prolonged post-transplant cytopenia associated with hypersplenism

Bone Marrow Transplantation volume 49, pages 717–719 (2014)Cite this article

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Splenectomy has been used in the past to shorten myeloid recovery following hematopoietic SCT (HSCT). Indeed, patients with myelofibrosis, chronic myelogeneous leukemia and other myeloproliferative disorders have more rapid myeloid recovery when a splenectomy is performed prior to HSCT.1, 2, 3, 4, 5, 6, 7 Also, having splenomegaly at the time of transplant has been associated with delayed platelet and neutrophil engraftment.5, 7 However, splenectomy has fallen out of favor because of the use of reduced intensity conditioning, PBSC source and growth factors, all of which shorten the duration of cytopenias post transplant. Studies have also showed no apparent survival benefit with splenectomy before transplant.3, 4, 6, 7 Still, splenectomy is recommended prior to HSCT in select patients with massive splenomegaly for alleviation of severe pain and shorten the duration of myeloid recovery following the transplant.7 In this report, we propose another potential indication for splenectomy in transplant recipients. Two HSCT recipients with prolonged post transplant cytopenias due to poor graft function and/or hypersplenism achieved normal blood counts following splenectomy with no short-term or long-term adverse consequences.

Patient A, a 68-year-old male with stage IV mantle cell lymphoma (MCL) and splenic involvement, underwent an autologous peripheral blood HSCT following myeloablative total body radiation (1200 cGy given in six fractions) and high dose CY at 60 mg/kg/day for 2 days. He received 2.3 × 106 CD34+cells/kg. Prior to HSCT, the patient’s relapsed MCL was in PR following six cycles of FCM-R (fludarabine, CY, mitoxantrone and rituximab) regimen. His early post transplant course was complicated by herpes zoster infection, which responded to antiviral therapy. He was discharged on day +13 after presumed myeloid recovery with ANC being greater than 2000. However, the patient remained anemic and persistently thrombocytopenic requiring transfusions. His WBC remained at a low-normal range with ANC greater than 500/mL. On day +28, his Hb was still 9.0 and platelet count was 24 000. Restaging studies on day +73 did not show any recurrent disease, but he had persistent massive splenomegaly by PET-CT. BM examination showed hypercellularity (60–70% cellularity) with left-shifted myeloid maturation. No lymphoma was seen by morphology, immunochemistry nor by flow cytometer.

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Authors and Affiliations

  1. University of Maryland Marlene and Stewart Greenebaum Cancer Center, Baltimore, MD, USA

    D L Brauer, A P Rapoport, S Yanovich & G Akpek

  2. Banner MD Anderson Cancer Center, Gilbert, AZ, USA

    G Akpek

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  1. D L Brauer
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  2. A P Rapoport
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  3. S Yanovich
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  4. G Akpek
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Correspondence to G Akpek.

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Brauer, D., Rapoport, A., Yanovich, S. et al. Splenectomy as a measure to treat prolonged post-transplant cytopenia associated with hypersplenism. Bone Marrow Transplant 49, 717–719 (2014). https://doi.org/10.1038/bmt.2013.238

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