TY - JOUR
T1 - Evaluation and management of hepatic dysfunction, portal hypertension and portal/splanchnic vein thrombosis in patients with myelofibrosis undergoing allogeneic haematopoietic cell transplantation
T2 - A practice based survey on behalf of the Chronic Malignancies Working Party of the EBMT
AU - Battipaglia, Giorgia
AU - Polverelli, Nicola
AU - Tuffnell, Joe
AU - Chiusolo, Patrizia
AU - Robin, Marie
AU - Gambella, Massimiliano
AU - Broers, Annoek
AU - Sala, Elisa
AU - Passweg, Jakob
AU - Furst, Sabine
AU - Friis, Lone Smidtrup
AU - Dulery, Remy
AU - de Witte, Moniek
AU - Srour, Micha
AU - Finazzi, Maria Chiara
AU - Wehr, Claudia
AU - Nagler, Arnon
AU - Richardson, Deborah
AU - Bethge, Wolfgang
AU - Clark, Andrew
AU - Drozd-Sokolowska, Joanna
AU - Raj, Kavita
AU - Czerw, Tomasz
AU - Hernández-Boluda, Juan Carlos
AU - McLornan, Donal P.
N1 - Publisher Copyright:
© 2024 The Author(s)
PY - 2025/1/1
Y1 - 2025/1/1
N2 - Heterogeneous approaches exist in regard to the management of disease-related co-morbidities in potential allogeneic haematopoietic cell transplantation (allo-HCT) candidates with myelofibrosis (MF). The EBMT Chronic Malignancies Working Party launched an electronic survey to evaluate how MF-specific comorbidities are approached and whether they ultimately affect the decision to transplant. A total of 41/63 (65%) Centers, all of whom were experienced in the management of MF allo-HCT, responded. Responses were aggregated and reported in a comparative fashion. Screening for portal hypertension (PH) was routinely performed in 54% centers, never in 12% and guided by clinical manifestations in the remaining. Involvement of hepatologists/gastroenterologists was always/very often considered in patients with signs of PH prior to transplant. Centers reported that radiological evidence of PH did not routinely represent a formal contraindication for allo-HCT in most cases (78%). Of note, most centers (61%) did not perform routine screening for gastroesophageal varices; this was systematically considered or guided by clinical manifestations in only 7% and 32% centers, respectively. Presence of gastroesophageal varices was always (15%) or occasionally (19%) considered a formal contraindication to allo-HCT. A prior history of portal vein thrombosis never (78%) or occasionally (15%) represented a formal contraindication. Three Centers would not proceed to transplant in such cases. Less importance was assigned to non-portal splanchnic vein thrombosis (SVT), with all but one centre proceeding to transplant regardless of prior SVT. This survey highlights a considerable heterogeneity across responding centers in approaching MF-related comorbidities prior to transplant, suggesting that harmonisation guidelines are needed to address these issues in this patient population.
AB - Heterogeneous approaches exist in regard to the management of disease-related co-morbidities in potential allogeneic haematopoietic cell transplantation (allo-HCT) candidates with myelofibrosis (MF). The EBMT Chronic Malignancies Working Party launched an electronic survey to evaluate how MF-specific comorbidities are approached and whether they ultimately affect the decision to transplant. A total of 41/63 (65%) Centers, all of whom were experienced in the management of MF allo-HCT, responded. Responses were aggregated and reported in a comparative fashion. Screening for portal hypertension (PH) was routinely performed in 54% centers, never in 12% and guided by clinical manifestations in the remaining. Involvement of hepatologists/gastroenterologists was always/very often considered in patients with signs of PH prior to transplant. Centers reported that radiological evidence of PH did not routinely represent a formal contraindication for allo-HCT in most cases (78%). Of note, most centers (61%) did not perform routine screening for gastroesophageal varices; this was systematically considered or guided by clinical manifestations in only 7% and 32% centers, respectively. Presence of gastroesophageal varices was always (15%) or occasionally (19%) considered a formal contraindication to allo-HCT. A prior history of portal vein thrombosis never (78%) or occasionally (15%) represented a formal contraindication. Three Centers would not proceed to transplant in such cases. Less importance was assigned to non-portal splanchnic vein thrombosis (SVT), with all but one centre proceeding to transplant regardless of prior SVT. This survey highlights a considerable heterogeneity across responding centers in approaching MF-related comorbidities prior to transplant, suggesting that harmonisation guidelines are needed to address these issues in this patient population.
KW - Gastroesophageal varices
KW - Hepatic dysfunction
KW - Myelofibrosis
KW - Portal hypertension
KW - Portal thrombosis
KW - Splanchnic vein thrombosis
KW - Transplantation
UR - http://www.scopus.com/inward/record.url?scp=85207318395&partnerID=8YFLogxK
U2 - 10.1016/j.retram.2024.103476
DO - 10.1016/j.retram.2024.103476
M3 - Article
AN - SCOPUS:85207318395
VL - 73
JO - Current Research in Translational Medicine
JF - Current Research in Translational Medicine
IS - 1
M1 - 103476
ER -