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 - 26/10/24
, Nicola Polverelli b, 1, Joe Tuffnell c, Patrizia Chiusolo d, Marie Robin e, Massimiliano Gambella f, Annoek Broers g, Elisa Sala h, Jakob Passweg i, Sabine Furst j, Lone Smidtrup Friis k, Remy Dulery l, Moniek de Witte m, Micha Srour n, Maria Chiara Finazzi o, Claudia Wehr p, Arnon Nagler q, Deborah Richardson r, Wolfgang Bethge s, Andrew Clark t, Joanna Drozd-Sokolowska u, Kavita Raj v, Tomasz Czerw w, Juan Carlos Hernández-Boluda x, Donal P. McLornan vAbstract |
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.
Le texte complet de cet article est disponible en PDF.Keywords : Myelofibrosis, Transplantation, Portal hypertension, Hepatic dysfunction, Splanchnic vein thrombosis, Portal thrombosis, Gastroesophageal varices
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Vol 73 - N° 1
Article 103476- janvier 2025 Retour au numéroBienvenue sur EM-consulte, la référence des professionnels de santé.
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