In patients with post-PV myelofibrosis who are ineligible for allogeneic stem cell transplant, how do you approach symptomatic splenomegaly refractory to splenic radiation and ruxolitinib?  

This is always a tough situation. First, I would make sure the patient is truly not a candidate for transplant. With reduced intensity conditioning and the addition of ruxolitinib before and after transplant, transplant is better tolerated than it once was. Otherwise, would consider switching to ano...