Insight

Jan 4, 2025, 09:52

Outcome of Splenectomy in JAK2 Inhibitor Treated Patients With Myelofibrosis

Mostafa Faisal, Adjunct Assistant Professor at Alfaisal University, shared a post on X:

“Outcome of Splenectomy in JAK2 Inhibitor Treated Patients With Myelofibrosis: A Mayo Clinic Experience in 34 Consecutive Cases.

Splenectomy in JAK2i-treated Myelofibrosis (MF):

62% had complications; 29% major bleeding.

Median survival post-splenectomy: 4.3 years.

ASCT bridge: 86% success, 65% 5-year survival (vs. 22% non-ASCT).

Splenectomy: viable for palliation and pre-transplant!”

Outcome of Splenectomy in JAK2 Inhibitor Treated Patients With Myelofibrosis: A Mayo Clinic Experience in 34 Consecutive Cases

Authors: Patricia Carey et al.

JAK2

This study evaluated outcomes of splenectomy in 34 myelofibrosis (MF) patients who previously received JAK inhibitor (JAKi) therapy. The cohort included patients with primary MF (53%), post-polycythemia vera MF (44%), and post-essential thrombocythemia MF (3%). Median age was 63 years, and the primary indications for splenectomy were symptomatic splenomegaly (79%), transfusion-dependent anemia (44%), and preparation for allogeneic stem cell transplant (41%).

Most patients had received one JAKi (76%), predominantly ruxolitinib, while 24% were treated with two or more JAKi. The median interval from MF diagnosis to splenectomy was 10.3 years.

Postoperative complications occurred in 62% of patients, including major bleeding (29%), thrombosis (26%), infections (15%), and other events like renal injury and pneumothorax. Overall survival post-splenectomy was 4.3 years, with 30-day and 60-day mortality rates of 6% and 15%, respectively. Causes of death included disease progression, infections, postoperative complications, graft-versus-host disease, and cardiac arrest.

This study highlights the potential role of splenectomy as a bridge to transplant or for symptom relief in MF patients with prior JAKi exposure but emphasizes significant risks of complications and mortality.