How would you treat severe, symptomatic splenomegaly in a patient with ET/MF who has progressed through all approved JAK inhibitors and is not a candidate for alloSCT?

Refractory symptomatic splenomegaly to JAK inhibition is thankfully not common but does occur and requires consideration of both pharmacologic and non-pharmacologic strategies.

Clinical trials should first be explored but if none are available or the patient is ineligible, then you can consider hypom...

This is a difficult situation where there are limited options. If there are clinical trials, would offer that first. If not, one can consider palliative radiation, though this only lasts a short period of time and can be associated with significant cytopenias. Splenectomy can be very beneficial but ...

It confirmed my practice. Would be reluctant to consider surgery for fear of perioperative mortality