The Effect Of Splenectomy On The Outcome Of Hematopoietic Stem Cell Transplantation In Children With Transfusions Dependent Thalassemia

Research Background At present,allogeneic hematopoietic stem cell transplantation is the only treatment that can cure transfusion dependent thalassemia in China,and whether splenectomy is necessary has not been clearly determined before hematopoietic stem cell transplantation.This study compared whether there was a statistical difference in relevant parameters between patients with severe thalassemia who underwent splenectomy before hematopoietic stem cell transplantation and those who did not undergo splenectomy in our transplant center in recent years.It has certain reference value for future splenectomy.Objective To evaluate whether there is a statistical difference between splenectomy before transplantation and without splenectomy in children with thalassaemia in a retrospective study.To further investigate the transplantation effect,complications and long-term prognosis of splenectomy before transplantation and without splenectomy.Methods A total of 92 patients(33 patients with splenectomy and 59 patients without splenectomy)from August 2010 to December 2018 were retrospectively analyzed and summarized.Follow-up was up to September 1,2021,with a median follow-up of 61.5 months.SPSS 25.0 statistical software was used for statistical analysis.Age,sex and ferritin before transplantation were tested by two independent samples t test.Mann-whitney U test was used to compare the infusion amount of peripheral blood stem cells,bone marrow and umbilical cord blood mononuclear and CD34+,the implantation time of the three lines and the amount of blood transfusion between the two groups.Chi-square test(Pearson chi-square when all T≥5,corrected Chi-square or Fisher’s exact probability method when 1≤T<5,Pearson chi-square or Fisher’s exact probability method,Fisher’s exact probability method is used when T<1)was used to compare the difference between the splenectomy group and the nonsplenectomy group.Kaplan-meier method was used to evaluate OS and EFS and draw survival curves.The comparison of OS and EFS between groups was performed by log-rank test.Cox regression was used to analyze the influence of covariables on OS and EFS rates.P<0.05 was considered statistically significant,and all P values were two-sided tests.Conclusion In splenectomy group,the overall survival rate was 93.8±4.2%,transplantrelated mortality rate was 6.2%,the Thalassemia-free survival was 87±5.8%,and the rejection rate was 6.06%.The overall survival rate was 96.6±2.4%,transplantrelated mortality was 3.4%,the Thalassemia-free survival was 90.9±5.9%,and the rate of rejection was 0%in the group without splenectomy.Splenectomy before transplantation had no significant effect on OS and TFS after transplantation,nor on implantation and rejection.Splenectomy helps neutrophils to be implanted more quickly and reduces the need for transfusion of red blood cells and platelets,but has no significant effect on the time of implantation of hemoglobin and platelets.In terms of complications,splenectomy before transplantation would increase the risk of sepsis,mainly with gram-negative bacteria.However,the overall infection rate including bacterial infection,viral infection,fungal infection has no significant effect.The age of splenectomy had no significant effect on the incidence of sepsis after transplantation.There was no significant difference in the incidence of acute and chronic graft-versus-host disease between the two groups.There was no significant difference in the risk of hepatic venous occlusive disease.No thrombosis or pulmonary hypertension occurred in the two groups.