Patients with myelofibrosis (MF) who have features of more advanced disease and more pronounced inflammation have higher estimated plasma volume status (ePVS) indicating expanded plasma volume, found a new study published in the journal Biochemica Medica.

Moreover, higher ePVS is associated with reduced survival in patients with both primary and secondary MF and higher thrombotic risk in patients with primary disease.

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These findings suggest that ePVS could be used as a prognostic marker in the MF.

Previous research has shown that high ePVS is associated with thrombotic risk in patients with polycythemia vera, a type of blood cancer. However, its potential prognostic role in MF is not known.

In the present study, a team of researchers from Croatia led by Rajko Kusec, MD, PhD, retrospectively analyzed 238 patients with primary and secondary MF in order to identify any clinical or prognostic associations between ePVS and survival.

They reported that the median ePVS of the patients was 5.8 dL/g and was not significantly different between patients with primary or secondary MF. 

However, patients who had features of more advanced disease, more pronounced inflammation, and higher comorbidity burden had higher ePVS, they found. 

Higher ePVS was also associated with shorter overall survival in patients with both primary and secondary MF. Finally, it was associated with a shorter time to thrombosis in patients with primary MF. 

The associations with overall survival were reduced when adjustments were made in multivariate analyses for the Dynamic International Prognostic Scoring System (DIPSS) and Myelofibrosis Secondary to PV and ET Prognostic Model (MYSEC-PM). However, the association with the time to thrombosis remained significant. This was independent of JAK2 mutation status, white blood cell count, and the presence of absence of chronic kidney disease.

“Our multicentric study highlights the importance of blood plasma evaluation to better understand thrombotic risk in [myeloproliferative neoplasm] patients,” the authors concluded.


Lucijanic M, Krecak I, Soric E, et al. Higher estimated plasma volume status is associated with increased thrombotic risk and impaired survival in patients with primary myelofibrosis. Biochem Med (Zagreb). Published online April 15, 2023. doi:10.11613/BM.2023.020901