@time4dje
Maybe this paper provides an answer:

Radiotherapy for symptom palliation of splenomegaly in patients with haematological malignancies
https://pmc.ncbi.nlm.nih.gov/articles/PMC8060855/

Hi @time4dje and welcome to Mayo Connect. Myelodysplastic syndromes (MDS) are a group of disorders caused by blood cells that are poorly formed or don't work properly. The spleen acts as a filter in the body and may enlarge in patients with MDS due to the increased destruction of blood cells. This can cause the spleen to work harder to filter out abnormal cells, resulting in enlargement.

As you’ve most likely discovered, when the spleen enlarges it’s uncomfortable causing you to feel full, have a decrease in your appetite or not allow you to breathe deeply as it compresses on other organs in that tight fit of the abdomen. You have my empathy…I speak from experience with another blood cancer.

Depending on the medications being received for MDS, often the treatments alone will help the spleen decrease in size. But sometimes if there is persistent enlargement radiation treatments or a splenectomy are used to bring some relief.

@swalex popped in with some good information from the National Institute of health regarding radiation treatments.

I’m also providing you with a couple of articles regarding MDS.
From Mayo Clinic:
https://www.mayoclinic.org/diseases-conditions/myelodysplastic-syndrome/symptoms-causes/syc-20366977
From Healthline: https://www.healthline.com/health/myelodysplastic-syndrome

There’s a pretty active support group of other members in Connect who have MDS. It can be so helpful to speak with others on the same journey. Please feel free to drop into any conversation to share your experiences. Here’s the link: https://connect.mayoclinic.org/search/

How long have you been diagnosied with MDS? Are you currently receiving other treatments?