Splenectomy does not improve survival in chronic active Epstein-Barr virus disease patients

We aimed to evaluate the clinical value of splenectomy as a treatment for Chronic active Epstein-Barr virus disease (CAEBVD). We retrospectively reviewed the clinical data from clinical records of patients received splenectomy in our institution from October 1, 2014, to October 1, 2024. The splenectomy cohort (n = 16) was matched to non-splenectomy controls (n = 32) at a 1:2 ratio using propensity scores derived from gender, age, baseline EBV-DNA copies, whether with HLH, and whether received Allo-HSCT. A total of 48 CAEBVD patients were enrolled in this study. Splenectomy cannot minimize the EBV-DNA copies in peripheral blood. The median OS of patients who received splenectomy was 86 months, while that of patients without splenectomy was 23 months. There was no statistically significant difference between the two groups (P = 0.189). When patients experienced recurrence-related death, no significant difference in survival time was observed between the two groups (P = 0.607). In the CAEBVD with HLH subgroup, there was no significant difference in survival times between patients with and without splenectomy (P = 0.423). A total of 18 patients received Allo-HSCT. The time to WBC and PLT engraftment between the non-splenectomy group and splenectomy group showed no significant difference (P = 0.788, P = 0.407). Splenectomy demonstrated no significant benefit in reducing EBV copies and symptom relief, and suggests splenectomy fails to prolong patient survival supporting its limited role in CAEBVD management.