Effect of splenectomy on pancytopenia after a peripheral blood stem cell transplantation

To analyze the effect of a splenectomy on pancytopenia after a peripheral blood stem cell transplantation (PBSCT) in chronic myeloid leukemia (CML) patients. Three CML patients diagnosed with splenomegaly in our department from 2002 to 2006 received a splenectomy after PBSCT. Patient 1, a 42-year-old male in chronic phase (CP), received an HLA-identical sibling allo-PBSCT. Patient 2, a 28-year-old female in aggressive phase (AP), received a PBSCT from her twin. Patient 3, a 26-year-old male in chronic phase (CP), received a PBSCT from an unrelated donor. The conditioning regimen included busulfan and cyclophosphamide (BU/CY2). Patients 1, 2, and 3 received splenectomies on days 168, 51, and 114, respectively. Bcr-abl transcripts were detected using the polymerase chain reaction (PCR). Chimerism was documented by PCR amplification of a variable number of tandem repeat (VNTR) polymorphrisms. Neither metrisone (2 mg/kg/day for 7 days), mycophenolic acid (MMF) (0.5 g twice daily for 1 month), high-dose γ-globulin (0.4 g/kg/day for 5 days), granulocyte colony-stimulating factor (G-CSF) therapy, nor erythropoietin (EPO) therapy had produced post-PBSCT hematopoiesis recovery. Patients 1 and 2 had 5% Ph-positive chromosomes while patient 3 exhibited graft-versus-host disease (GVHD). After receiving the splenectomy, all three had a rapid hematopoeitic recovery with no evidence of Ph-positive chromosomes, and patients 1 and 3 showed complete donor chimerism (CDC). Patient 1 developed chronic GVHD (cGVHD) on day 210 postsplenectomy that was treated successfully with prednisone. Patient 2 had acute GVHD on day 55 that was treated successfully with dexamethasone (10 mg), administered intravenously once a day for 3 days with good clinical response. To date, patients 1, 2, and 3 have survived postprocedure for 85, 49, and 25 months, respectively. Splenectomy is an effective option for the patients who have pancytopenia after PBSCT and the patients recovered a good graft function after splenectomy without procedure-related complication and with long-time survival. GVHD can develop in both allo-PBSCT and syngeneic PBSCT. A splenectomy after PBSCT may increase the risk of GVHD, enhance the effect of graft versus leukemia (GVL), promote CDC formation.