Assessing the Clinical Impact of Post-Transplant Splenectomy in Primary Myelofibrosis

Researchers reported two cases of post-allogeneic hematopoietic cell transplant (alloHCT) splenectomy and found that it’s a viable option in treating some patients with primary myelofibrosis (PMF). The study was presented at the 2021 TCT Meetings of ASTCT & CIBMTR Digital Experience.

In the first case, a patient with PMF underwent alloHCT following ineffective ruxolitinib treatment. Splenectomy pretransplant was deferred, given the advanced state of the disease. Researchers noted that the patient was 100% donor chimerism, and a repeated bone marrow biopsy did not reveal evidence of progressive disease. The patient underwent splenectomy on day 71 and is currently 50 months post-transplant with normal blood readings and mild chronic liver and gastrointestinal GVHD, on low-dose mycophenolate mofetil.

The second case detailed an instance where splenectomy was deferred pre-transplant, as the patient showed marrow blast up to 10% from time of diagnosis. Although the patient achieved absolute neutrophil count (ANC) engraftment, they developed worsening neutropenia and remained red blood cell and platelet transfusion dependent. On day 42, the researchers noted that repeated bone marrow biopsy did not reveal evidence of excess blast, and CALR mutation was negative. On day 49, the patient underwent splenectomy, and within a few days, he achieved ANC engraftment.

The researchers wrote in conclusion that post-transplant splenectomy “results in resolution of delayed engraftment. Critical neutropenia pre-splenectomy may result in a worse postoperative course.”

Read more at: https://tct.confex.com/tct/2021/meetingapp.cgi/Paper/17599.

Pelke L, et al. Clinical Outcomes of Post Allogeneic Stem Cell Transplant Splenectomy in Primary Myelofibrosis for Delayed Engraftment. Published for the 2021 TCT Meetings of ASTCT & CIBMTR Digital Experience; February 8-12, 2021.