脾肿大对慢性粒-单核细胞白血病异基因造血干细胞移植预后的影响

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.