ArticleEJHaem2026
Sequential High-Dose Ruxolitinib and Low-Dose Splenic Irradiation for Pretransplant Management of Splenomegaly Before Allogeneic Hematopoietic Cell Transplantation With Fludarabine/Busulfan-Based Conditioning in Myelofibrosis.
Article in EJHaem, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
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Abstract
Background: Significant splenomegaly remains a major barrier to successful allogeneic hematopoietic cell transplantation (allo-HCT) in myelofibrosis (MF), contributing to delayed engraftment and an increased risk of graft failure. Systemic JAK inhibition and splenic irradiation are commonly used as independent pretransplant strategies; however, evidence regarding their sequential use and integration into contemporary conditioning platforms remains limited. Methods: We conducted a single-center retrospective study of nine patients with MF who underwent allo-HCT between 2020 and 2025. Patients received sequential high-dose ruxolitinib followed by low-dose splenic irradiation (LDSI) as pretransplant spleen-directed therapy prior to a fludarabine/busulfan-based conditioning regimen. Spleen response, engraftment kinetics, and transplant outcomes were evaluated. Results: High-dose ruxolitinib reduced median spleen length from 185 to 172 mm, followed by a further decrease to 137 mm after LDSI. All patients achieved engraftment, with median times to neutrophil and platelet recovery of 15 and 19 days, respectively. The cumulative incidence of any-grade acute graft-versus-host disease (GVHD) was 22.2%, and moderate chronic GVHD occurred in 11.1%. The estimated 2-year overall survival was 88.9%, and the estimated 2-year GVHD-free and relapse-free survival (GRFS) was 76.2%. The estimated 2-year cumulative incidence of relapse was 12.7%, and estimated non-relapse mortality was 11.1%. Conclusion: Sequential high-dose ruxolitinib followed by LDSI appeared feasible and was associated with stepwise pretransplant spleen reduction and encouraging early transplant outcomes following allogeneic HCT with fludarabine/busulfan-based conditioning. Given the small sample size and absence of a comparator group, this combined systemic and local spleen-directed strategy warrants further evaluation in prospective multicenter studies. Trial Registration: The authors have confirmed clinical trial registration is not needed for this submission.
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