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

Peter Kalhs, Ilse Schwarzinger, Garnet Anderson, Motomi (Tomi) Mori, Reginald A. Clift, Rainer Storb, C. Dean Buckner, Frederick R. Appelbaum, John A. Hansen, Keith M. Sullivan

Research output: Contribution to journalArticle

38 Citations (Scopus)

Abstract

The present study was performed as a retrospective analysis of the role of pretransplant splenectomy to determine the incidence of late bacterial infections, acute and chronic graft-versus-host disease (GVHD), relapse, and survival among 358 patients receiving HLA-identical marrow grafts for chronic myelogenous leukemia. Sixty-eight (19%) of the 358 patients had undergone splenectomy before transplantation. There was a trend towards more grade II-IV acute GVHD among splenectomized patients, but this was not significant in the multivariate analysis. The incidence of chronic GVHD was similar for splenectomized and nonsplenectomized patients. Late infectious complications did not significantly differ between splenectomized and control patients (rates per patient year were 0.16 and 0.14, respectively). The overall risk of leukemic relapse was significantly increased for splenectomized patients (56% v 32% for controls, P = .001) and control patients with splenomegaly (P <.0001). Splenectomy and splenomegaly remained significant and independent hazards for relapse in the multivariate analysis (hazard ratio [HR], 1.82, P = .029; and HR, 1.49, P = .002; respectively). Relapse was also increased in patients with advanced disease (HR, 2.95; P = .0001), in patients with T-cell-depleted marrow (HR, 4.51; P = .0001), and in the female donor and male recipient combination (HR, 1.74; P = .044). Patients with splenectomy had an increased overall mortality (HR, 1.18), but this was not statistically significant in the multivariate analysis. In summary, our study showed no significant influence of splenectomy on late posttransplant infections, acute or chronic GVHD, or overall survival. There was no evidence that splenectomy decreased recurrence of chronic myelogenous leukemia.

Original languageEnglish (US)
Pages (from-to)2028-2032
Number of pages5
JournalBlood
Volume86
Issue number5
StatePublished - Sep 1 1995
Externally publishedYes

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Homologous Transplantation
Graft vs Host Disease
Splenectomy
Leukemia, Myelogenous, Chronic, BCR-ABL Positive
Grafts
Hazards
Bone Marrow
Recurrence
Survival
Infection
Multivariate Analysis
Splenomegaly
T-cells
Incidence
Bacterial Infections
Transplantation
Tissue Donors
T-Lymphocytes
Transplants

ASJC Scopus subject areas

  • Hematology

Cite this

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. / Kalhs, Peter; Schwarzinger, Ilse; Anderson, Garnet; Mori, Motomi (Tomi); Clift, Reginald A.; Storb, Rainer; Buckner, C. Dean; Appelbaum, Frederick R.; Hansen, John A.; Sullivan, Keith M.

In: Blood, Vol. 86, No. 5, 01.09.1995, p. 2028-2032.

Research output: Contribution to journalArticle

Kalhs, P, Schwarzinger, I, Anderson, G, Mori, MT, Clift, RA, Storb, R, Buckner, CD, Appelbaum, FR, Hansen, JA & Sullivan, KM 1995, '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, vol. 86, no. 5, pp. 2028-2032.
Kalhs, Peter ; Schwarzinger, Ilse ; Anderson, Garnet ; Mori, Motomi (Tomi) ; Clift, Reginald A. ; Storb, Rainer ; Buckner, C. Dean ; Appelbaum, Frederick R. ; Hansen, John A. ; Sullivan, Keith M. / 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. In: Blood. 1995 ; Vol. 86, No. 5. pp. 2028-2032.
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title = "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",
abstract = "The present study was performed as a retrospective analysis of the role of pretransplant splenectomy to determine the incidence of late bacterial infections, acute and chronic graft-versus-host disease (GVHD), relapse, and survival among 358 patients receiving HLA-identical marrow grafts for chronic myelogenous leukemia. Sixty-eight (19{\%}) of the 358 patients had undergone splenectomy before transplantation. There was a trend towards more grade II-IV acute GVHD among splenectomized patients, but this was not significant in the multivariate analysis. The incidence of chronic GVHD was similar for splenectomized and nonsplenectomized patients. Late infectious complications did not significantly differ between splenectomized and control patients (rates per patient year were 0.16 and 0.14, respectively). The overall risk of leukemic relapse was significantly increased for splenectomized patients (56{\%} v 32{\%} for controls, P = .001) and control patients with splenomegaly (P <.0001). Splenectomy and splenomegaly remained significant and independent hazards for relapse in the multivariate analysis (hazard ratio [HR], 1.82, P = .029; and HR, 1.49, P = .002; respectively). Relapse was also increased in patients with advanced disease (HR, 2.95; P = .0001), in patients with T-cell-depleted marrow (HR, 4.51; P = .0001), and in the female donor and male recipient combination (HR, 1.74; P = .044). Patients with splenectomy had an increased overall mortality (HR, 1.18), but this was not statistically significant in the multivariate analysis. In summary, our study showed no significant influence of splenectomy on late posttransplant infections, acute or chronic GVHD, or overall survival. There was no evidence that splenectomy decreased recurrence of chronic myelogenous leukemia.",
author = "Peter Kalhs and Ilse Schwarzinger and Garnet Anderson and Mori, {Motomi (Tomi)} and Clift, {Reginald A.} and Rainer Storb and Buckner, {C. Dean} and Appelbaum, {Frederick R.} and Hansen, {John A.} and Sullivan, {Keith M.}",
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AU - Schwarzinger, Ilse

AU - Anderson, Garnet

AU - Mori, Motomi (Tomi)

AU - Clift, Reginald A.

AU - Storb, Rainer

AU - Buckner, C. Dean

AU - Appelbaum, Frederick R.

AU - Hansen, John A.

AU - Sullivan, Keith M.

PY - 1995/9/1

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N2 - The present study was performed as a retrospective analysis of the role of pretransplant splenectomy to determine the incidence of late bacterial infections, acute and chronic graft-versus-host disease (GVHD), relapse, and survival among 358 patients receiving HLA-identical marrow grafts for chronic myelogenous leukemia. Sixty-eight (19%) of the 358 patients had undergone splenectomy before transplantation. There was a trend towards more grade II-IV acute GVHD among splenectomized patients, but this was not significant in the multivariate analysis. The incidence of chronic GVHD was similar for splenectomized and nonsplenectomized patients. Late infectious complications did not significantly differ between splenectomized and control patients (rates per patient year were 0.16 and 0.14, respectively). The overall risk of leukemic relapse was significantly increased for splenectomized patients (56% v 32% for controls, P = .001) and control patients with splenomegaly (P <.0001). Splenectomy and splenomegaly remained significant and independent hazards for relapse in the multivariate analysis (hazard ratio [HR], 1.82, P = .029; and HR, 1.49, P = .002; respectively). Relapse was also increased in patients with advanced disease (HR, 2.95; P = .0001), in patients with T-cell-depleted marrow (HR, 4.51; P = .0001), and in the female donor and male recipient combination (HR, 1.74; P = .044). Patients with splenectomy had an increased overall mortality (HR, 1.18), but this was not statistically significant in the multivariate analysis. In summary, our study showed no significant influence of splenectomy on late posttransplant infections, acute or chronic GVHD, or overall survival. There was no evidence that splenectomy decreased recurrence of chronic myelogenous leukemia.

AB - The present study was performed as a retrospective analysis of the role of pretransplant splenectomy to determine the incidence of late bacterial infections, acute and chronic graft-versus-host disease (GVHD), relapse, and survival among 358 patients receiving HLA-identical marrow grafts for chronic myelogenous leukemia. Sixty-eight (19%) of the 358 patients had undergone splenectomy before transplantation. There was a trend towards more grade II-IV acute GVHD among splenectomized patients, but this was not significant in the multivariate analysis. The incidence of chronic GVHD was similar for splenectomized and nonsplenectomized patients. Late infectious complications did not significantly differ between splenectomized and control patients (rates per patient year were 0.16 and 0.14, respectively). The overall risk of leukemic relapse was significantly increased for splenectomized patients (56% v 32% for controls, P = .001) and control patients with splenomegaly (P <.0001). Splenectomy and splenomegaly remained significant and independent hazards for relapse in the multivariate analysis (hazard ratio [HR], 1.82, P = .029; and HR, 1.49, P = .002; respectively). Relapse was also increased in patients with advanced disease (HR, 2.95; P = .0001), in patients with T-cell-depleted marrow (HR, 4.51; P = .0001), and in the female donor and male recipient combination (HR, 1.74; P = .044). Patients with splenectomy had an increased overall mortality (HR, 1.18), but this was not statistically significant in the multivariate analysis. In summary, our study showed no significant influence of splenectomy on late posttransplant infections, acute or chronic GVHD, or overall survival. There was no evidence that splenectomy decreased recurrence of chronic myelogenous leukemia.

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