Pretransplant Splenic Irradiation in Patients With Myeloproliferative Neoplasms

2024 update on allogeneic hematopoietic stem cell transplant for myelofibrosis: A review of current data and applications on risk stratification and management

“…Intermediate risk showed better OS (HT, 0.49; p = .039) when compared with high risk. Similarly, pre‐HCT MIPSS70+ v2.0 showed better OS for intermediate (HR0.29) compared with high risk and much lower OS when VHR were compared with HR (5.05) 19 . A risk scoring combing clinical‐molecular characteristics for MF patients undergoing HCT has been devised: it allows stratification into four risk groups—low (score 0–2), intermediate (score 3–4), high (score 5), and very high (score >5).…”

“…13 Finally splenic irradiation can reduce the size of the spleen, without significant vascular complications, as seen in splenectomy, and initial results seem promising. 19 For patients with massive splenomegaly, it is likely that only significant spleen reduction will happen after the transplant, and in those cases, if there is poor graft function and complete donor chimerism, splenectomy may be performed after the transplant. Patients who are expected to undergo splenectomy should receive vaccine against neiserria meningitidis, streptococcus pneunmoniae, and hemophillus influenzae as well as antibiotics prophylaxis for these.…”

“…Splenectomy is the second option to reduce spleen volume before transplantation: the procedure is feasible in most patients, but it is not free of complications, especially thrombosis: splenectomy has been associated with faster hematologic recovery, but possibly a higher risk of relapse, resulting in no survival advantage 13 . Finally splenic irradiation can reduce the size of the spleen, without significant vascular complications, as seen in splenectomy, and initial results seem promising 19 . For patients with massive splenomegaly, it is likely that only significant spleen reduction will happen after the transplant, and in those cases, if there is poor graft function and complete donor chimerism, splenectomy may be performed after the transplant.…”

MRI-Guided Radiation Therapy for Splenomegaly: Clinical Experiences and Technical Tips

“…Historically, radiotherapy (RT) has always been reserved in a palliative or salvage setting, in patients un t for surgery, due to poor performance status or advanced age, or unresponsive to medical therapies (Zaorsky et al 2017). Although paucity of data in the literature, several studies reported bene ts in terms of pain relief, symptom and cytopenia improvement, as well as a bridge to allogenic hematopoietic cell transplantation (HCT), which is the only de nitive treatment option for these patients (Sager et al 2015;Zaorsky et al 2017;Ponce et al 2022). Low doses of RT are effectively prescribed for the treatment of splenomegaly.…”

“…2021) to 81.8%(Sager et al 2015), with 72% reported in a meta-analysis by Zaorsky et al(Zaorsky et al 2017), although the case series include patients with splenomegaly caused by various medical conditions.Regarding the extent of reduction, Sager et al(Sager et al 2015) and Katano et al(Katano et al 2021) observed a reduction in spleen size of 50% and a mean ± SD variation rate in spleen volume of -19.1 ± 24.7%, respectively. Furthermore, Ponce et al(Ponce et al 2022), in a study of 17 patients, including 14 with MFI, who underwent SI followed by HCT, reported a median craniocaudal reduction in spleen size of 7.3%.…”