Impact of cytoreductive therapy in myeloproliferative neoplasm-associated splanchnic vein thrombosis

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.

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Journal
Blood Advances
Published
2026-08-20
DOI
https://doi.org/10.1182/bloodadvances.2026020925
Primary Topic
Myeloproliferative Neoplasms: Diagnosis and Treatment
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article
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article

Impact of cytoreductive therapy in myeloproliferative neoplasm-associated splanchnic vein thrombosis

Mukul Aggarwal, Ronald Hoffman, Alessandra Iurlo, Joan D. Beckman et al.
Blood Advances
Myeloproliferative Neoplasms: Diagnosis and Treatment
article

Impact of cytoreductive therapy in myeloproliferative neoplasm-associated splanchnic vein thrombosis

Mukul Aggarwal, Ronald Hoffman, Alessandra Iurlo, Joan D. Beckman, Atefeh Ghorbanzadeh, Paola Guglielmelli, Amiya Ranjan Nayak, Joan How, Damon E. Houghton, Radhika Gangaraju, Rushad Patell, Pavlina Chrysafi, Sargam Kapoor, Abishta Prabhu, Kristen M. Sanfilippo, Alessandro Maria Vannucchi, Vrushali Pachpande, Valerio De Stefano, Thita Chiasakul, Gabriela Hobbs, Andrew M. Peseski, Mandy N. Lauw, Ruchi Desai, John O Mascarenhas, Guoliang Zheng, Lisa Baumann Kreuziger, Walter Ageno, Margherita Maffioli, Valentina Boldrini, Sai Sudha Valisekka, Daniele Cattaneo, Sai Swetha Alladi, Shreyash Dalmia, Alejandro Godoy, Douglas Tremblay, Balkrishna Jahagirdar, Vinai Chander Bhagirath, Dahniel Sastow, A.K. Ko, Rebecca L. Zon, Silvia Betti, Jonathan Berry, Rishi Dhawan, Elena Rossi, Maria Georgen
article en

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.

Blood Advances
Brigham and Women's Hospital (US), Beth Israel Deaconess Medical Center (US), Mayo Clinic (US), Memorial Sloan Kettering Cancer Center (US), University of Padua (IT), Chulalongkorn University (TH), Duke University (US), Virginia Commonwealth University (US), Medical College of Wisconsin (US), Washington University in St. Louis (US), University of Minnesota System (US), Ospedale di Circolo e Fondazione Macchi (IT), Erasmus MC (NL), King Chulalongkorn Memorial Hospital (TH), Agostino Gemelli University Polyclinic (IT), Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico (IT), University of Alabama at Birmingham (US), Massachusetts General Hospital (US), Mount Sinai Medical Center (US), Duke Raleigh Hospital (US), Azienda Ospedaliero-Universitaria Careggi (IT), Versiti Blood Center of Wisconsin (US), Dana-Farber Cancer Institute (US), Istituto Nazionale di Documentazione Innovazione e Ricerca Educativa (IT), University of Minnesota Medical Center (US), Istituti di Ricovero e Cura a Carattere Scientifico (IT), Capital Health (US), University of Florence (IT), HealthPartners (US), All India Institute of Medical Sciences (IN), McMaster University (CA), Icahn School of Medicine at Mount Sinai (US)
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Myeloproliferative Neoplasms: Diagnosis and Treatment
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