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The latter include progressive splenomegaly, symptomatic portal hypertension (e.g. ascites, variceal bleeding), pulmonary hypertension, bone pain, intractable pruritus, constitutional symptoms (e.g. fatigue, night sweats) and cachexia (i.e. loss of lean body mass, general ill health, poor appetite). Some of these symptoms are directly or indirectly related to extramedullary hematopoiesis (EMH) and others to proinflammatory cytokine excess. Results from recent clinical trials of JAK inhibitors suggest remarkable activity in MF\u2010associated constitutional symptoms, cachexia, pruritus and hydroxyurea\u2010refractory splenomegaly. Involved\u2010field radiotherapy is best utilized in the setting of EMH\u2010associated symptoms, including ascites, bone (extremity) pain and pulmonary hypertension. Splenectomy is indicated in the presence of drug\u2010refractory splenomegaly and frequent red cell transfusion requirement. Transjugular intrahepatic portosystemic shunt is used to alleviate symptoms of portal hypertension.<\/jats:p>","DOI":"10.1111\/j.1600-0609.2010.01480.x","type":"journal-article","created":{"date-parts":[[2010,6,2]],"date-time":"2010-06-02T16:29:10Z","timestamp":1275496150000},"page":"192-199","source":"Crossref","is-referenced-by-count":21,"title":["Treatment options for hydroxyurea\u2010refractory disease complications in myeloproliferative neoplasms: JAK2 inhibitors, radiotherapy, splenectomy and transjugular intrahepatic portosystemic 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