Battipaglia, Giorgia; Polverelli, Nicola; Tuffnell, Joe; Chiusolo, Patrizia; Robin, Marie; Gambella, Massimiliano; Broers, Annoek; ... McLornan, Donal P; + view all Battipaglia, Giorgia; Polverelli, Nicola; Tuffnell, Joe; Chiusolo, Patrizia; Robin, Marie; Gambella, Massimiliano; Broers, Annoek; Sala, Elisa; Passweg, Jakob; Furst, Sabine; Friis, Lone Smidtrup; Dulery, Remy; de Witte, Moniek; Srour, Micha; Finazzi, Maria Chiara; Wehr, Claudia; Nagler, Arnon; Richardson, Deborah; Bethge, Wolfgang; Clark, Andrew; Drozd-Sokolowska, Joanna; Raj, Kavita; Czerw, Tomasz; Hernandez-Boluda, Juan Carlos; McLornan, Donal P; - view fewer (2025) Evaluation and management of hepatic dysfunction, portal hypertension and portal/splanchnic vein thrombosis in patients with myelofibrosis undergoing allogeneic haematopoietic cell transplantation: A practice based survey on behalf of the Chronic Malignancies Working Party of the EBMT. Current Research in Translational Medicine , 73 (1) , Article 103476. 10.1016/j.retram.2024.103476.

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Abstract

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.

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