[Impact of splenomegaly on outcomes of allogeneic hematopoietic stem cell transplantation in patients with chronic myelomonocytic leukemia].

Objective

To retrospectively analyzed the impact of splenomegaly on outcomes in patients with chronic myelomonocytic leukemia (CMML) receiving allogeneic hematopoietic stem cell transplantation (allo-HSCT) .

Methods

Clinical data of 25 patients with CMML receiving allo-HSCT at Peking University Institute of Hematology from 2004-2018 were retrospectively analyzed. Engraftment, graft versus host disease (GVHD) , relapse, survival were compared between patients with or without splenomegaly before transplantation.

Results

There were 15 splenomegaly patients including 8 males and 7 females with a median age of 45 (23-61) years, and 10 non-splenomegaly patients including 5 males and 5 females with a median age of 39 (12-56) years. Clinical characteristics at baseline were comparable in two groups (P>0.05) . The neutrophil engraftment rates in splenomegaly and non-splenomegaly patients were 93.3% (14/15) and 100.0% (10/10) , and with a median time of 17 (11-20) days and 14 (11-18) days respectively (χ(2)=5.303, P=0.021) . The platelet engraftment rates in splenomegaly and no-splenomegaly patients were 80.0% (12/15) and 90.0% (9/10) (P=0.212) , and the median time of engraftment was 17 (12-33) days and 15 (12-19) days respectively (χ(2)=0.470, P=0.493) . Five patients with splenomegaly developed acute GVHD (aGVHD) (4 patients with grade Ⅰ/Ⅱ, 1 with grade Ⅲ/Ⅳ) , and 6 patients developed aGVHD in non-splenomegaly group (5 with grade Ⅰ/Ⅱ, 1 with grade Ⅲ/Ⅳ) (χ(2)=0.204, P=0.652) . The cumulative incidences of aGVHD at 100 days between two groups were 33.3% (95%CI 14.9%-51.7%) and 20.0% (95%CI 2.8%-37.2%) respectively (P=0.635) . Five patients in splenomegaly group developed chronic GVHD (cGVHD) including 3 patients with extensive cGVHD. None in non-splenomegaly group reported cGVHD (P=0.041) . The 3-year cumulative incidences of relapse in splenomegaly and non-splenomegaly patients were (42.7±2.6) % and (11.1±1.2) % (P=0.122) , and the 3-year overall survival rates were (61.5±13.5) % and (68.6±15.1) % (χ(2)=0.351, P=0.554) . In addition, the leukemia-free survival rates were (56.3±14.8) % and (80.0±17.9) % respectively (χ(2)=1.148, P=0.284) .

Conclusion

In CMML patients receiving allo-HSCT, splenomegaly may have an impact on the time of neutrophil engraftment, but not affecting disease relapse and survival.