Does splenectomy improve outcomes for myelofibrosis treated with allogeneic stem cell transplant
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- Answered 7 Mar 2020 Conflict of interest declaration: None I searched PubMed using two approaches [1, 2] and found a number of papers, but have concentrated on two recent examples. It appears that the answer is unknown! A 2017 paper  concluded: "....some patients with huge splenomegaly may undergo pretransplantation splenectomy without a deleterious impact on post-transplantation outcomes. OS and EFS improvement should in confirmed in controlled study." A 2019 paper highlights the uncertainty : "Splenectomy before allogeneic stem cell transplantation (ASCT) for patients with myelofibrosis (MF) remains a matter of debate, and conflicting results have been reported to date. The procedure seems to fasten post-transplant hematological recovery, but it does not have an impact on survival." Until a good RCT is performed we'll probably never know the answer! References 1) https://pubmed.ncbi.nlm.nih.gov/?term=myelofibrosis+AND+%22stem+cell%22+AND+splenectomy&filter=simsearch1.fha 2) https://pubmed.ncbi.nlm.nih.gov/?term=((%22Primary+Myelofibrosis%22%5BMesh%5D)+AND+(+%22Stem+Cell+Transplantation%22%5BMesh%5D+OR++%22Hematopoietic+Stem+Cell+Transplantation%22%5BMesh%5D+))+AND+%22Splenectomy%22%5BMesh%5D 3) https://pubmed.ncbi.nlm.nih.gov/28263921-the-impact-of-splenectomy-in-myelofibrosis-patients-before-allogeneic-hematopoietic-stem-cell-transplantation 4) https://pubmed.ncbi.nlm.nih.gov/30617767-splenic-irradiation-before-allogeneic-stem-cell-transplantation-for-myelofibrosis