Radiation therapy for symptomatic hepatomegaly in myelofibrosis with myeloid metaplasia.
OBJECTIVE
To describe the experience with liver irradiation in advanced cases of myelofibrosis with myeloid metaplasia (MMM).


METHODS
Over a 20-yr period, 14 patients with MMM were treated with a total of 25 courses of liver, abdominal, or abdominal and pelvic irradiation for symptomatic hepatomegaly with (5 patients) or without (9 patients) ascites. All 14 patients had advanced disease and 11 (79%) had previous splenectomy. The median radiation therapy (RT) dose per course was 150 cGy (range 50-1000) administered at a median of six fractions. Four patients received two to six courses.


RESULTS
Twelve of the 14 patients (86%) had a transient (median 3 months) subjective response from RT. However, in only 35% of these was there a transient (median 3 months) decrease in palpable liver size. Four of the five patients with ascites experienced a short-term response from RT. Eight of the 13 patients suitable for evaluation (62%) had treatment-associated cytopenia, often in the form of anemia and/or thrombocytopenia. At last follow-up, 10 patients (71%) had died after a median of 7 months (range 0.1-23) and 4 were alive at 3, 20, 33, and 57 months after RT.


CONCLUSIONS
Low-dose abdominal RT for symptomatic hepatomegaly or ascites associated with advanced-stage MMM is myelosuppressive and provides only temporary and mainly subjective and short-lived relief.
Tefferi
A
A
Division of Hematology and Internal Medicine and Mayo Clinic and Mayo Foundation, Rochester, Minnesota 55905, USA.
Jiménez
T
T
Gray
L A
LA
Mesa
R A
RA
Chen
M G
MG
D000005:Abdomen / Q000528:radiation effects; D000368:Aged; D000369:Aged, 80 and over; D000740:Anemia / Q000209:etiology; D001201:Ascites / Q000209:etiology / Q000532:radiotherapy; D001772:Blood Cell Count; D019583:Dose Fractionation, Radiation; D005260:Female; D005500:Follow-Up Studies; D006454:Hemoglobins / Q000032:analysis; D006529:Hepatomegaly / Q000209:etiology / Q000473:pathology / Q000532:radiotherapy*; D006801:Humans; D008099:Liver / Q000473:pathology / Q000528:radiation effects; D008297:Male; D008875:Middle Aged; D010166:Palliative Care; D010388:Pelvis / Q000528:radiation effects; D055728:Primary Myelofibrosis / Q000150:complications* / Q000401:mortality; D011882:Radiotherapy, High-Energy / Q000009:adverse effects; D012189:Retrospective Studies; D013156:Splenectomy; D013921:Thrombocytopenia / Q000209:etiology; D016896:Treatment Outcome
D006454:Hemoglobins