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Splenic irradiation prior to allogeneic hematopoietic cell transplantation for patients with myelofibrosis

Bone Marrow Transplantation volume 58, pages 459–461 (2023)Cite this article

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Myelofibrosis (MF) is a rare, BCR-ABL negative myeloproliferative neoplasm characterized by excess fibrous tissue formation in the bone marrow, constitutional symptomology, progressive anemia, and reduced overall survival [1, 2]. Despite treatment advancements, the only curative therapy for MF is allogeneic hematopoietic cell transplantation (HCT). Patients with MF often have compensatory splenic extramedullary hematopoiesis causing symptomatic splenomegaly [3]. Janus kinase (JAK) inhibitors, including ruxolitinib (RUX), fedratinib, and pacritinib, are standard therapy in managing splenomegaly [4]. Unfortunately, many patients do not pharmacologically achieve resolution of splenomegaly, and those patients with splenomegaly at time of transplant have worse clinical outcomes [5, 6].

Given the negative association of splenomegaly with transplant outcomes, efforts to reduce spleen size beyond JAK inhibition should be considered. Splenectomy is often associated with a high risk of morbidity and mortality in MF patients [7]. Splenic radiation therapy (RT), however, is a non-invasive modality that results in temporary reduction of splenomegaly [8]. Therefore, RT may be attractive leading into allogenic HCT [9]. Given the paucity of data evaluating splenic RT prior to HCT, we performed a retrospective study aimed at (1) describing the results of patients who received splenic RT prior to allogeneic HCT, and (2) assessing engraftment and survival rates with this approach in association with JAK inhibitor therapy.

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Data availability

The datasets generated during and/or analyzed during the current study are available from the corresponding author on reasonable request.

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Authors and Affiliations

  1. Department of Medical Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA

    John R. Bales, Roxana Portillo & Gabriela S. Hobbs

  2. Department of Data Science, Dana-Farber Cancer Institute, Boston, MA, USA

    Haesook T. Kim

  3. Department of Radiation Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA

    Chirayu Patel

  4. Hematopoietic Cell Transplant and Cellular Therapy Program, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA

    Steven McAfee, Bimalangshu Dey, Thomas Spitzer, Yi-Bin Chen, Areej El-Jawahri & Zachariah DeFilipp

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  1. John R. Bales
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  11. Gabriela S. Hobbs
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Contributions

JRB was responsible for extracting and analyzing data, interpreting results, updating reference lists, and writing the report. HTK was responsible for analyzing data and interpreting results. She also contributed to writing the report. RP was responsible for extracting data. CP, SM, BD, TS, YBC, and AEJ all provided feedback on the report. ZD and GSH were responsible for designing the study protocol, interpreting and analyzing study results, and providing feedback on the report.

Corresponding author

Correspondence to Gabriela S. Hobbs.

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The authors declare no competing interests.

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Bales, J.R., Kim, H.T., Portillo, R. et al. Splenic irradiation prior to allogeneic hematopoietic cell transplantation for patients with myelofibrosis. Bone Marrow Transplant 58, 459–461 (2023). https://doi.org/10.1038/s41409-023-01913-9

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  • DOI: https://doi.org/10.1038/s41409-023-01913-9

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