Impact of cytoreductive therapy in myeloproliferative neoplasm-associated splanchnic vein thrombosis
Year: 2026
Type: article
Study design: Observational Study
Abstract: Myeloproliferative neoplasm (MPN) patients are at risk of splanchnic vein thromboses (SVT). Prior studies have failed to demonstrate a benefit of hydroxyurea therapy in preventing recurrent thrombosis after SVT, but are limited by small sample sizes and inability to account for starting, stopping, or switching of cytoreductive therapies. To better assess the impact of cytoreductive therapy on thrombosis recurrence, we performed a retrospective cohort study of MPN-SVT patients from the international GASTRO-MPN Consortium, treating cytoreductive therapy as a time-dependent covariate. We identified 757 patients, of which 43% were treated with cytoreductive therapy. During a median follow-up of 7.4 years, 256 patients (34%) had thrombosis recurrence; 145 (19%) had SVT extension/recurrence/TIPS thrombosis, 138 (18%) an thrombosis recurrence outside the splanchnic bed (74% were venous). Additionally, 262 patients (35%) experienced clinically relevant bleeding and 170 (22%) died. After adjusting for age, sex, prior thrombosis, timing of MPN diagnosis relative to SVT, anticoagulation initiation within 30 days of SVT diagnosis, MPN type, JAK2 status, other cancers and cirrhosis, cytoreductive therapy was associated with a decreased risk of recurrent thrombosis (HR 0.67 95%CI 0.50-0.89, p=0.01). This was driven by a lower risk of SVT extension/recurrence (HR 0.62 95%CI 0.42-0.90, p=0.01) but not by extra-splanchnic thrombosis recurrence (HR 0.97 95%CI 0.72-1.30, p=0.82). In a subgroup of patients without erythrocytosis/thrombocytosis at initial SVT (n=275), cytoreductive therapy was associated with a HR 0.65 (95%CI 0.40-1.07, p=0.09) for recurrent thrombosis. These data support the use of cytoreductive therapy in MPN-SVT patients to prevent recurrent thrombosis, particularly SVT extension/recurrence.
Source: Blood Advances
Authors: Douglas Tremblay, Amica Kurniati Ko, Pavlina Chrysafi, Joan How, Rebecca L. Zon, Damon E Houghton, Atefeh Ghorbanzadeh, Dahniel Sastow, Sai Swetha Alladi, Maria Georgen, Abishta Prabhu, Vrushali Pachpande, Sai Sudha Valisekka, Balkrishna N Jahagirdar, Sargam Kapoor, Andrew Peseski, Radhika Gangaraju, Ruchi Desai, Guoliang Zheng, Shreyash Dalmia, Vinai Chander Bhagirath, Alejandro Godoy, Alessandra Iurlo, Daniele Cattaneo, Paola Guglielmelli, Alessandro M Vannucchi, Valentina Boldrini, Valerio De Stefano, Silvia Betti, Elena Rossi, Walter Ageno, Jonathan Berry, Margherita Maffioli, Mukul Aggarwal, Amiya Ranjan Nayak, Rishi Dhawan, Thita Chiasakul, Kristen Sanfilippo, Gabriela S Hobbs, John O. Mascarenhas, Ronald Hoffman, Lisa Baumann Kreuziger, Rushad D Patell, Joan D Beckman, Mandy N. Lauw
Institutions: Icahn School of Medicine at Mount Sinai, Erasmus MC, Memorial Sloan Kettering Cancer Center, Brigham and Women's Hospital, Dana-Farber Cancer Institute, Mayo Clinic, Capital Health, Medical College of Wisconsin, University of Minnesota, University of Minnesota Medical Center, HealthPartners, Duke University, University of Alabama at Birmingham, Virginia Commonwealth University, McMaster University, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Azienda Ospedaliero-Universitaria Careggi, University of Florence, Agostino Gemelli University Polyclinic, Istituti di Ricovero e Cura a Carattere Scientifico, University of Padua, Beth Israel Deaconess Medical Center, Ospedale di Circolo e Fondazione Macchi, Aziende Socio Sanitarie Territoriale dei Sette Laghi, All India Institute of Medical Sciences, Chulalongkorn University, King Chulalongkorn Memorial Hospital, Washington University in St. Louis, Massachusetts General Hospital, Versiti Blood Center of Wisconsin
Language: English
Subfield: Genetics
Field: Medicine
Domain: Health Sciences
Open Access status: gold
Estimated APC paid: $3,800
OpenAlex ID: W7203826495
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