How would you treat severe, symptomatic splenomegaly in a patient with ET/MF who has progressed through all approved JAK inhibitors and is not a candidate for alloSCT?  

Refractory symptomatic splenomegaly to JAK inhibition is thankfully not common but does occur and requires consideration of both pharmacologic and non-pharmacologic strategies.Clinical trials should first be explored but if none are available or the patient is ineligible, then you can consider hypom...

This is a difficult situation where there are limited options. If there are clinical trials, would offer that first. If not, one can consider palliative radiation, though this only lasts a short period of time and can be associated with significant cytopenias. Splenectomy can be very beneficial but ...