Time to development of splanchnic vein thrombosis (SVT)-related complications in patients with myeloproliferative neoplasms (MPNs) is not influenced by whether the patient was receiving MPN-directed therapy, according to results of a retrospective analysis published in the European Journal of Haematology.
An increased risk of thrombosis is a characteristic of MPNs, including polycythemia vera (PV), essential thrombocythemia (ET), and primary myelofibrosis (PMF). Specifically, SVT has been reported in up to 8.2% of patients with MPNs, and has been associated with an increased risk of portal hypertension, resulting in the development of esophageal variceal bleeding and ascites. However, whether treatment of MPNs in the setting of SVT has an impact on the development of these liver-associated clinical sequelae is unclear.
This study included a cohort of 64 patients with an MPN and SVT. Median ages at diagnosis of MPN and SVT were 43 years and 45 years, respectively. Of these patients, the MPN-related diagnosis was PV in 45% of patients, ET in 22%, and PMF in 13%, with the remaining patients having unclassifiable MPN-related disease or with pre- or post-MPN. SVT occurred prior to the MPN diagnosis in 30% of patients, concurrent with the diagnosis in 26% of patients, or following the MPN diagnosis in 44% of patients.
At a median follow-up of 61 months after development of SVT, esophageal variceal bleeding occurred in 20% of patients, ascites in 47%, and hepatic encephalopathy in 9% of patients.
A key finding from this study was that there was no difference in the time to development of any of these clinical manifestations of portal hypertension for those receiving MPN-directed therapy at the time of SVT vs those who did not.
The study authors concluded that “future studies are required to further clarify the optimal therapeutic strategies for patients with an MPN‐associated SVT.”
Tremblay D, Vogel AS, Moshier E, et al. Outcomes of splanchnic vein thrombosis in patients with myeloproliferative neoplasms in a single center experience [published online October 6, 2019]. Eur J Haematol. doi: 10.1111/ejh.1335