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Splenic irradiation prior to allogeneic transplant conditioning in myelofibrosis: A pilot experience. | LitMetric

AI Article Synopsis

  • Allogeneic stem cell transplantation is a strong treatment for Myelofibrosis (MF), and splenic irradiation can help shrink the spleen and improve symptoms.
  • A study looked at 14 MF patients who had this treatment from June 2016 to March 2021, and most had successful results, with many seeing a decrease in spleen size after three months.
  • After about 25 months, some patients were no longer needing transfusions, but a few had relapses or sadly passed away, showing that more research is needed to confirm these results.

Article Abstract

Introduction: In the era of JAK inhibitors, allogeneic stem cell transplantation (HSCT) remains the only curative treatment for patients with Myelofibrosis (MF). Splenic irradiation (SI) may be used to reduce spleen size and related symptoms.

Methods: We conducted a retrospective analysis on 14 patients with MF who underwent HSCT with SI from any donor source at our center between June 2016 and March 2021. All patients received a conditioning backbone based on treosulfan and fludarabine, with post-transplant cyclophosphamide (PTCy) and sirolimus as graft-versus-host disease (GvHD) prophylaxis. Patients received SI with 10 Gy involved-field radiotherapy in five 2-Gy fractions over the course of a week prior to the beginning of conditioning.

Results: At transplant all patients were transfusion-dependent and had splenomegaly (median bipolar diameter by ultrasound: 20.75 cm). Overall, 12 patients had received ruxolitinib prior to transplant. Re-evaluation of spleen dimensions was available for 13 patients: median splenic bipolar diameter after at least 3 months from transplant decreased by a median of 25%. With a median post-transplant follow-up of 25 months, 6 patients remain in CR with full-donor chimerism, 3 patients died due to NRM. Overall, 4 patients relapsed. At last follow-up, nine patients are currently alive and achieved transfusion-independence.

Conclusions: In a small cohort of mostly ruxolitinib pre-treated patients, SI and treosulfan-based conditioning appeared a safe and effective tool to reduce spleen dimensions and ameliorate symptoms. Future prospective studies with adequate sample size are warranted to further investigate the usefulness and safety of this approach in MF.

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Source
http://dx.doi.org/10.1016/j.retram.2023.103400DOI Listing

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