Table 1.
Characteristics of patients (≥ 18), who received myeloablative conditioning allogeneic hematopoietic cell transplantation from 1990 to 2006 by spleen status.
| Characteristics of patients | Normal Spleen |
Splenomegaly | Splenic irradiation |
Splenectomy | P-valuee |
|---|---|---|---|---|---|
| Patient related | |||||
| Number of patients | 7440 | 1471 | 300 | 472 | |
| Number of centers | 317 | 227 | 53 | 133 | |
| Age at transplant, median (range), years | 39 (18 – 59) | 37 (18 – 59) | 39 (18 – 59) | 39 (18 – 60) | 0.1498 |
| 18–21 | 288 (4) | 58 (4) | 12 (4) | 12 (3) | 0.4484 |
| 21–40 | 3884 (52) | 815 (55) | 157 (52) | 242 (51) | |
| 41–60 | 3226 (43) | 590 (40) | 129 (43) | 216 (46) | |
| >60 | 42 (1) | 8 (1) | 2 (1) | 2 (<1) | |
| Male Sex | 4273 (57) | 989 (67) | 187 (62) | 272 (58) | <0.001 |
| Karnofsky score at transplant ≥90 | 5899 (79) | 1130 (77) | 259 (86) | 330 (70) | <0.001 |
| Disease related | |||||
| Disease | <0.001 | ||||
| Chronic myelogenous leukemia | 5745 (77) | 1229 (84) | 266 (89) | 310 (66) | |
| Myelodysplasia disorders (MDS) | 1530 (21) | 133 (9) | 25 (8) | 72 (15) | |
| Myeloproliferative disorders (MPD)1 | 95 (1) | 90 (6) | 8 (3) | 72 (15) | |
| Other MDS/MPD NOS | 70 (<1) | 19 (1) | 1 (<1) | 18 (4) | |
| Disease status at transplant | |||||
| MDS | 0.3397 | ||||
| Early | 509 (33) | 38 (29) | 9 (36) | 16 (22) | |
| Advanced | 983 (64) | 93 (70) | 16 (64) | 55 (76) | |
| Non Evaluable | 38 (2) | 2 (2) | 0 | 1 (1) | |
| FAB subtype | <0.001 | ||||
| RAEB-t | 362 (24) | 28 (21) | 4 (16) | 16(22) | |
| RAEB | 504 (33) | 33 (26) | 6 (24) | 22 (32) | |
| CMML | 84 (6) | 27 (20) | 4 (16) | 15(21) | |
| RARS | 48 (3) | 4 (3) | 2 (8) | 1 (2) | |
| RA | 393 (26) | 15 (11) | 8 (32) | 9 (12) | |
| Other MDS | 139 (9) | 26 (20) | 1(4) | 9 (12) | |
| CML | <0.001 | ||||
| Chronic phase | 4999 (87) | 958 (78) | 226 (85) | 225 (72) | |
| Accelerated Phase | 746 (13) | 271 (22) | 40 (13) | 85 (28) | |
| Transplant related | |||||
| Donor type | <0.001 | ||||
| HLA identical sibling | 3539 (48) | 1119 (76) | 184 (61) | 219 (46) | |
| Unrelated Donor | 3901 (52) | 352 (24) | 116 (39) | 253 (54) | |
| Year of transplant | <0.001 | ||||
| 1990–1994 | 2461 (33) | 634 (43) | 208 (69) | 208 (44) | |
| 1995–1999 | 3002 (40) | 514 (35) | 74 (25) | 170 (36) | |
| 2000–2004 | 1487 (20) | 251 (17) | 16 (5) | 78 (17) | |
| 2005–2006 | 490 (7) | 72 (5) | 2 (<1) | 16 (3) | |
| Graft type | <0.001 | ||||
| Bone marrow | 6044 (81) | 1160 (79) | 286 (95) | 390 (83) | |
| Peripheral blood | 1396 (19) | 311 (21) | 14 (5) | 82 (17) | |
| Donor/recipient sex match | <0.001 | ||||
| Male-Male | 2616 (35) | 586 (40) | 109 (36) | 156 (33) | |
| Male-Female | 1632 (22) | 396 (27) | 78 (26) | 113 (24) | |
| Female-Male | 1668 (22) | 254 (17) | 59 (20) | 111 (24) | |
| Female-Female | 1482 (20) | 226 (15) | 53 (18) | 89 (19) | |
| Unknown | 42 (<1) | 9 (<1) | 1 (<1) | 3 (<1) | |
| Donor/recipient CMV match | <0.001 | ||||
| Negative/Negative | 2095 (28) | 347 (24) | 95 (32) | 141 (30) | |
| Positive/Positive | 2490 (33) | 656 (45) | 94 (31) | 128 (27) | |
| Positive/Negative | 965 (13) | 164 (11) | 41 (14) | 63 (13) | |
| Negative/Positive | 1596 (21) | 226 (15) | 51 (17) | 115 (24) | |
| Unknown | 294 (4) | 78 (5) | 19 (6) | 25 (5) | |
| HLA match status | <0.001 | ||||
| Well matched | 1315 (18) | 70 (5) | 14 (5) | 62 (13) | |
| Partially matched | 1516 (20) | 152 (10) | 32 (11) | 97 (21) | |
| Mismatched | 1064 (14) | 130 (9) | 70 (23) | 91 (19) | |
| HLA-Identical siblings | 3545 (48) | 1119 (76) | 184 (61) | 221 (46) | |
| Growth factor use | 2146 (29) | 353 (24) | 70 (23) | 165 (35) | <0.001 |
| Conditioning regimen | <0.001 | ||||
| CY + TBI | 4164 (56) | 527 (36) | 268 (89) | 311 (66) | |
| Bu + CY | 3242 (44) | 930 (63) | 32 (11) | 160 (34) | |
| Other2 | 34 (<1) | 14 (<1) | 0 | 1 (<1) | |
| ATG use | 659 (9) | 134 (9) | 19 (6) | 60 (13) | 0.0107 |
| Splenic radiation type | |||||
| Reported as part of conditioning | N/A | N/A | 289 (96) | N/A | |
| Reported as part of MDS treatment | N/A | N/A | 11 (4) | N/A | |
| Time from splenic RT to tx, median (range), days | N/A | N/A | 10 (<1 – 296) | N/A | |
| Median dose of splenic radiation, cGy | N/A | N/A | 900 (8–5000) | N/A | |
| GVHD prophylaxis | <0.001 | ||||
| T-cell depletion | 928 (12) | 96 (7) | 77 (26) | 143 (30) | |
| CSA + MTX ± other | 4999 (67) | 1146 (78) | 182 (61) | 251 (53) | |
| Tacro + MTX± other | 776 (10) | 48 (3) | 8 (3) | 34 (7) | |
| CSA ± Other | 514 (7) | 145 (10) | 24 (8) | 29(6) | |
| Other | 223(4) | 36 (2) | 9(2) | 15(4) | |
| BM TNC×108 cells/kg, median (range) | 3 (<1–11) | 3 (<1–13) | 2 (<1–7) | 3 (<1–9) | <0.001 |
| PB CD34×106 cells/kg, median (range) | 4 (<1 – 78) | 4 (<1 – 355) | 2 (<1 – 10) | 4 (<1 – 549) | 0.2745 |
| Median follow-up of survivors, range, months | 97 (2–234) | 103(1–230) | 116 (5–228) | 107(1–221) |
Abbreviations: CSA= cyclosporine; MTX=methotrexate; TBI= total body irradiation; Bu=busulfan; Cy=cyclophosphamide; GVHD= graft vs host disease; tacro= Tacrolimus; CML= chronic myelogenous leukemia; TNC=total nucleated cell dose; NOS=not otherwise specified.
1
MPD other disease subtype includes subtype: Myelofibrosis with myeloid metaplasia (n=20), polycythemia vera, Essential/primary thrombocythemia and Juvenile CML.)
2
Other conditioning regimen includes Cy± Other (n=48) Fludarabine + Atg ± other (n=1).\