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A Mouse Model of Vascularized Heterotopic Spleen Transplantation for Studying Spleen Cell Biology and Transplant Immunity
Published on: June 11, 2019
Splenectomy for poor graft function after allogeneic bone marrow transplantation in patients with chronic myeloid
C Richard1, I Romón, M Perez-Encinas
1Department of Hematology, Marqués de Valdecillá University Hospital, Santander, Spain.
Insights
Splenectomy successfully treated poor graft function in four chronic myeloid leukemia (CML) patients post-bone marrow transplantation (BMT). This intervention led to complete hematological recovery and sustained patient survival.
Area of Science:
- Hematology
- Transplantation Immunology
Background:
- Chronic myeloid leukemia (CML) patients undergoing non-T-depleted bone marrow transplantation (BMT) can experience poor graft function.
- Enlarged spleens were noted in three of the four patients prior to BMT.
Purpose of the Study:
- To evaluate the efficacy of splenectomy in correcting poor graft function in CML patients post-BMT.
Main Methods:
- Four CML patients received non-T-depleted BMT from HLA-compatible sibling donors.
- Conditioning involved cyclophosphamide (CY) and total body irradiation (TBI).
- Splenectomy was performed due to poor graft function, with pre-splenectomy BM showing aplasia or hypocellularity.
Main Results:
- All four patients achieved complete hematological recovery post-splenectomy.
- Bone marrow cellularity normalized within one month, and complete donor chimerism was documented.
- All patients survived, with follow-up ranging from 16 to 58 months post-BMT.
Conclusions:
- Splenectomy is an effective treatment for poor graft function in CML patients following BMT.
- This approach can lead to sustained hematological recovery and long-term survival.
Abstract:
We report four patients with chronic myeloid leukemia (CML) that showed poor graft function after a non-T-depleted bone marrow transplantation (BMT) from an HLA-compatible sibling donor and who were successfully treated with splenectomy. Conditioning was done with cyclophosphamide (CY) and total body irradiation (TBI) without additional splenic irradiation. Three patients had enlarged spleens before BMT. The nucleated cell dose infused ranged from 2.3-3.2 x 10(8)/kg. Bone marrow (BM) examination prior to splenectomy showed BM aplasia (three cases) or hypocellularity (one case). At splenectomy no patient had evidence of cytomegalovirus (CMV) infection or severe acute GVHD; and three patients had moderately enlarged spleens. All patients were transfusion dependent. Complete hematological recovery was obtained in all patients. BM cellularity was normal 1 month after splenectomy. Complete chimerism of donor origin was documented. The four patients are alive (+16 to +58 months after BMT). Thus, in patients with CML, a poor graft function may be successfully corrected by splenectomy.
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