ORIGINAL RESEARCH article
Front. Immunol.
Sec. Alloimmunity and Transplantation
This article is part of the Research TopicAllo-HSCT: novel clinical applications and therapeutic strategies in adults and analysis of rare procedure complicationsView all 6 articles
Effect of Pretransplant Spleen Volume on the Prognosis of Acute Myeloid Leukemia Treated with Allogeneic Hematopoietic Stem Cell Transplantation
Provisionally accepted
- 1Department of Hematology & Hematology key institute in Second Hospital of Hebei Medical University, Department of Hematology, Second Hospital of Hebei Medical University, Shijiazhuang, China
- 2Department of Function, The Second Hospital of Hebei Medical University, Shijiazhuang, China
- 3Department of Imaging, The Second Hospital of Hebei Medical University, Shijiazhuang, China
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Objective: This study aimed to evaluate the influence of pre-transplant spleen volume on the prognosis of patients with acute myeloid leukemia (AML) undergoing allogeneic hematopoietic stem cell transplantation (allo-HSCT). Methods: We evaluated 58 AML patients diagnosed with AML and undergone first allogeneic stem cell transplant at the Department of Hematology, Second Hospital of Hebei Medical University from 2017 to 2022. All patients were consecutively evaluated. Patients with AML evolving from myeloproliferative neoplasms (MPN) or secondary AML were excluded. Only de novo AML patients were included . The median follow-up time was 24 months and categorized into non-enlarged spleen volume (NLSV) and large spleen volume (LSV) groups based on spleen volume ranges of 120 normal individuals. A retrospective analysis was performed to evaluate the impact of spleen volume on post-allo-HSCT outcomes, including the incidence of infection, graft-versus-host disease (GVHD), relapse, overall survival (OS), and non-relapse mortality (NRM). The log-rank test was employed to compare survival curves, and a multivariable Cox regression model was utilized to assess spleen volume as a prognostic factor for long-term survival. Results: According to the survival curve, the LSV group exhibited lower OS compared to the NLSV group (P=0.034), along with higher cumulative NRM (P=0.049) and lower relapse-free survival (P=0.023). No significant differences were observed in disease relapse, granulocyte engraftment, CMV infection, or GVHD incidence. The multivariable regression model confirmed spleen volume as a significant risk factor for OS, with cytomegalovirus (CMV) infection also influencing OS and NRM. Conclusions: Pre-transplant splenomegaly is independently associated with poor prognosis in AML patients.
Keywords: Acute Myeloid Leukemia, Hematopoietic Stem Cell Transplantation, Non-relapse mortality, prognosis, Spleen volume, Splenomegaly
Received: 29 Jul 2025; Accepted: 17 Dec 2025.
Copyright: © 2025 LIU, Bingjie, Pang, Zhou, Wang, Zhang and Wang. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Ying Wang
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