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Impact of pretransplant splenectomy on patients with β‐thalassemia major undergoing a matched‐related allogeneic stem cell transplantation
Author(s) -
Mathews Vikram,
George Biju,
Lakshmi Kavitha M.,
Viswabandya Auro,
John Joseph M.,
Sitaram Usha,
Daniel Dolly,
Chandy Mammen,
Srivastava Alok
Publication year - 2009
Publication title -
pediatric transplantation
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.457
H-Index - 69
eISSN - 1399-3046
pISSN - 1397-3142
DOI - 10.1111/j.1399-3046.2008.00953.x
Subject(s) - medicine , splenectomy , gastroenterology , thalassemia , incidence (geometry) , transplantation , surgery , platelet , spleen , physics , optics
Impact of pretransplant splenectomy in patients with β‐thalassemia major undergoing an allogeneic SCT has never been addressed. Twenty‐seven class III patients (29 transplants) had a pretransplant splenectomy. The outcome of these 29 transplants was compared with 76 transplants in class III who did not have a splenectomy. Patients in the splenectomy group were older (11.7 ± 5.0 vs. 8.5 ± 3.5 yr; p = 0.003) and had a larger liver size (5.7 ± 1.8 vs. 4.4 ± 1.6 cm; p = 0.000). Splenectomized patients had a significantly faster time to ANC >500/mm 3 (15.4 ± 5.9 vs. 17.5 ± 4 days; p = 0.002) and platelet >20 000/mm 3 (22.5 ± 6.7 vs. 32.5 ± 13.6 days; p = 0.000). The splenectomized group had a significantly reduced requirement of blood transfusion in the first 100 days post‐transplant (5.5 ± 5.1 vs. 7.2 ± 5.4 units; p = 0.017). There were significantly more deaths related to peri‐transplant infections in the post‐splenectomy group (24% vs. 5.3%; p = 0.0001). The graft rejections were comparable between the two groups (20.7% vs. 14.5%; p = 0.55). The incidence of acute and chronic GVHD, late infections, and deaths from RRT was not significantly different between the two groups. The five‐yr EFS (31.0 ± 8.6 vs. 60.8 ± 5.98; p = 0.003) and OS (39.7 ± 9.3 vs. 71.8 ± 5.5; p = 0.002) was significantly worse in the splenectomized group. In conclusion, pretransplant splenectomy among patients with β‐thalassemia major was associated with faster engraftment, reduced transfusion support, a higher incidence of peri‐transplant infection related deaths, and a reduced EFS and OS.