Luther Marlene, Henes Frank Oliver, Zabelina Tatjana, Massoud Radwan, Janson Dietlinde, Wolschke Christine, Klyuchnikov Evgeny, Gagelmann Nico, Fehse Boris, Adam Gerhard, Kröger Nicolaus, Ayuk Francis
Department of Stem Cell Transplantation, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany.
Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany.
Bone Marrow Transplant. 2023 Jul;58(7):755-761. doi: 10.1038/s41409-023-01968-8. Epub 2023 Mar 31.
Splenomegaly is a hallmark of myelofibrosis (MF), and reports on the impact of spleen size on the outcome of allo-HSCT have been conflicting, possibly due to differences in methods of assessment. We retrospectively analysed the impact of spleen volume and length measured by computed tomography on allo-HSCT outcome in 93 patients, 74% of whom had prior ruxolitinib treatment. Median spleen volume and length were 1.58 dm and 20 cm, respectively. We found a strong correlation between spleen volume and length (Pearson's r = 0.95, p < 0.001), Spearman (rho = 0.96, p < 0.001). After a median follow-up of 41.7 months, 5-year overall and disease-free survival were 66% and 59%, respectively. Spleen size did not impact overall survival or non-relapse mortality. Larger spleen volume and length as continuous variables were associated with slower platelet and leucocyte engraftment and a higher risk of disease relapse in univariate and multivariate analyses. Spleen length measured precisely by imaging is a good surrogate for spleen volume. In the era of JAK inhibitors, larger spleen size reflects advanced disease in MF and is associated with an increased risk of relapse but has no impact on non-relapse mortality and overall survival after allo-HSCT.
脾肿大是骨髓纤维化（MF）的一个标志，关于脾脏大小对异基因造血干细胞移植（allo-HSCT）结果的影响的报道一直存在矛盾，这可能是由于评估方法的差异所致。我们回顾性分析了93例患者中通过计算机断层扫描测量的脾脏体积和长度对allo-HSCT结果的影响，其中74%的患者曾接受过芦可替尼治疗。脾脏体积中位数和长度分别为1.58立方分米和20厘米。我们发现脾脏体积和长度之间存在很强的相关性（Pearson相关系数r = 0.95，p < 0.001），Spearman相关系数（rho = 0.96，p < 0.001）。中位随访41.7个月后，5年总生存率和无病生存率分别为66%和59%。脾脏大小不影响总生存率或非复发死亡率。在单变量和多变量分析中，作为连续变量的较大脾脏体积和长度与血小板和白细胞植入较慢以及疾病复发风险较高相关。通过影像学精确测量的脾脏长度是脾脏体积的良好替代指标。在JAK抑制剂时代，较大的脾脏大小反映了MF的疾病进展，并且与复发风险增加相关，但对allo-HSCT后的非复发死亡率和总生存率没有影响。
