Objective: To retrospectively analyzed the impact of splenomegaly on outcomes in patients with chronic myelomonocytic leukemia (CMML) receiving allogeneic hematopoietic stem cell transplantation (allo-HSCT) . Methods: Clinical data of 25 patients with CMML receiving allo-HSCT at Peking University Institute of Hematology from 2004-2018 were retrospectively analyzed. Engraftment, graft versus host disease (GVHD) , relapse, survival were compared between patients with or without splenomegaly before transplantation. Results: There were 15 splenomegaly patients including 8 males and 7 females with a median age of 45 (23-61) years, and 10 non-splenomegaly patients including 5 males and 5 females with a median age of 39 (12-56) years. Clinical characteristics at baseline were comparable in two groups (P>0.05) . The neutrophil engraftment rates in splenomegaly and non-splenomegaly patients were 93.3% (14/15) and 100.0% (10/10) , and with a median time of 17 (11-20) days and 14 (11-18) days respectively (χ(2)=5.303, P=0.021) . The platelet engraftment rates in splenomegaly and no-splenomegaly patients were 80.0% (12/15) and 90.0% (9/10) (P=0.212) , and the median time of engraftment was 17 (12-33) days and 15 (12-19) days respectively (χ(2)=0.470, P=0.493) . Five patients with splenomegaly developed acute GVHD (aGVHD) (4 patients with grade Ⅰ/Ⅱ, 1 with grade Ⅲ/Ⅳ) , and 6 patients developed aGVHD in non-splenomegaly group (5 with grade Ⅰ/Ⅱ, 1 with grade Ⅲ/Ⅳ) (χ(2)=0.204, P=0.652) . The cumulative incidences of aGVHD at 100 days between two groups were 33.3% (95%CI 14.9%-51.7%) and 20.0% (95%CI 2.8%-37.2%) respectively (P=0.635) . Five patients in splenomegaly group developed chronic GVHD (cGVHD) including 3 patients with extensive cGVHD. None in non-splenomegaly group reported cGVHD (P=0.041) . The 3-year cumulative incidences of relapse in splenomegaly and non-splenomegaly patients were (42.7±2.6) % and (11.1±1.2) % (P=0.122) , and the 3-year overall survival rates were (61.5±13.5) % and (68.6±15.1) % (χ(2)=0.351, P=0.554) . In addition, the leukemia-free survival rates were (56.3±14.8) % and (80.0±17.9) % respectively (χ(2)=1.148, P=0.284) . Conclusion: In CMML patients receiving allo-HSCT, splenomegaly may have an impact on the time of neutrophil engraftment, but not affecting disease relapse and survival.
目的： 探讨脾肿大对慢性粒-单核细胞白血病（CMML）异基因造血干细胞移植（allo-HSCT）预后的影响。 方法： 对2004年至2018年在北京大学血液病研究所接受allo-HSCT后的25例CMML患者进行回顾性分析，根据预处理前2周是否伴有脾脏肿大分为脾肿大组和非脾肿大组，比较两组患者在植入、移植物抗宿主病（GVHD）、复发以及生存方面的差异。 结果： ①脾肿大组15例（男8例，女7例），中位年龄45（23~61）岁；非脾肿大组10例（男、女各5例），中位年龄39（12~56）岁。两组患者基线特征差异无统计学意义（P>0.05）。②脾肿大组、非脾肿大组粒细胞植入率分别为93.3%（14/15）、100.0%（10/10），中位植入时间分别为17（11~20）d、14（11~18）d（χ(2)=5.303，P=0.021）；脾肿大组、非脾肿大组血小板植入率分别为80.0%（12/15）、90.0%（9/10）（P=0.212），中位植入时间分别为17（12~33）d、15（12~19）d（χ(2)=0.470，P=0.493）。③脾肿大组5例发生急性GVHD（Ⅰ/Ⅱ度4例，Ⅲ/Ⅳ度1例），非脾肿大组6例发生急性GVHD（Ⅰ/Ⅱ度5例，Ⅲ/Ⅳ度1例）（χ(2)=0.204，P=0.652）。脾肿大组、非脾肿大组移植后100 d的急性GVHD累积发生率分别为33.3%（95%CI 14.9%~51.7%）、20.0%（95%CI 2.8%~37.2%）（P=0.635）。脾肿大组5例发生慢性GVHD（广泛型3例），非脾肿大组未发生慢性GVHD（P=0.041）。④脾肿大组、非脾肿大组3年累积复发率分别为（42.7±2.6）%、（11.1±1.2）%（χ(2)=1.824，P=0.122），3年总生存率分别为（61.5±13.5）%、（68.6±15.1）%（χ(2)=0.351，P=0.554），3年无白血病生存率分别为（56.3±14.8）%、（80.0±17.9）%（χ(2)=1.148，P=0.284）。 结论： 脾肿大可致CMML患者allo-HSCT后粒细胞植入延迟，对生存及复发无影响。.
Keywords: Chronic myelomonocytic leukemia; allogeneic hematopoietic stem cell transplantation; splenomegaly.