Is there any role for elective splenectomy before allogeneic hematopoietic stem cell transplantation in patients with CMML who have massive splenomegaly?
Some hematologists believe that the risk of relapse can be reduced by performing splenectomy before allogeneic hematopoietic stem cell transplantation in patients with CMML, and it is considered to help with reducing the leukemic burden; however, I am not sure about this argument. That is why I have asked this question.
The risk of leaving a massive spleen in a patient about to undergo allogeneic BMT is of engraftment in the spleen. This is not only seen in patients with PMF, but also with other haematological disorders associated with massive splenomegaly.
We performed splenectomy in a 4 y.o. JMML patient post HSCT cca D35 (huge spleen, poor engraftment) with an excellent result. I am not aware of any guidelines, but it always depends on a particular clinical situation.