Splenectomy does not improve survival in chronic active Epstein-Barr virus disease patients
Junzhe Wang1, Xiaodan He1, Deli Song1
1Department of Hematology, Beijing Friendship Hospital, Capital Medical University, 95 YongAn Road, Xicheng District, Beijing, 100050, China.
Insights
Splenectomy does not reduce Epstein-Barr virus (EBV) DNA levels or improve survival in Chronic Active Epstein-Barr Virus Disease (CAEBVD). This study suggests splenectomy has a limited role in managing CAEBVD patients.
Area of Science:
- Immunology
- Virology
- Surgical Oncology
Background:
- Chronic Active Epstein-Barr Virus Disease (CAEBVD) is a severe condition requiring effective treatment strategies.
- Splenectomy is a potential intervention, but its clinical value in CAEBVD remains unclear.
- Understanding the impact of splenectomy on viral load and patient outcomes is crucial for treatment decisions.
Purpose of the Study:
- To evaluate the clinical efficacy of splenectomy in managing Chronic Active Epstein-Barr Virus Disease (CAEBVD).
- To assess the impact of splenectomy on Epstein-Barr virus (EBV) DNA levels and patient survival.
- To determine if splenectomy influences outcomes in CAEBVD patients, particularly those with Hemophagocytic Lymphohistiocytosis (HLH) or who undergo Allogeneic Hematopoietic Stem Cell Transplantation (Allo-HSCT).
Main Methods:
- Retrospective review of clinical data from 48 CAEBVD patients (October 2014 - October 2024).
- A cohort of 16 patients who underwent splenectomy was propensity score matched (1:2 ratio) with 32 non-splenectomy controls.
- Analysis included EBV-DNA levels, overall survival (OS), recurrence-related death, and engraftment times post-Allo-HSCT.
Main Results:
- Splenectomy did not significantly reduce peripheral blood EBV-DNA copies.
- There was no statistically significant difference in median overall survival between the splenectomy (86 months) and non-splenectomy (23 months) groups (P=0.189).
- No significant benefits were observed in symptom relief, survival time after recurrence-related death, or engraftment times in patients undergoing Allo-HSCT.
Conclusions:
- Splenectomy shows no significant benefit in reducing EBV viral load or improving symptom relief in CAEBVD.
- The procedure does not appear to prolong patient survival, indicating a limited role in CAEBVD management.
- Further research may be needed to explore alternative or adjunctive therapies for CAEBVD.
Abstract:
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.
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