A low platelet-to-lymphocyte ratio and a high ferritin level are associated with poor prognosis in patients with myelofibrosis (MF), according to a new study by Turkish researchers published in Scientific Reports. On the contrary, a high systemic immune-inflammation (SII) index and systemic inflammation response index are not.

The team led by Fahir Özkalemkaş, MD, PhD, from the division of hematology, department of internal medicine, faculty of medicine, Bursa Uludag University, Türkiye, evaluated, for the first time, the impact of inflammatory markers on the prognosis of MF. These markers have prognostic significance for many cancers but have never been evaluated in MF before.

In the present study, the team retrospectively analyzed 60 MF patients who were diagnosed between March 2011 and September 2022. 

The median overall survival of the patients was 64 months. This was significantly shorter in patients aged more than 65 years. These patients had high levels of ferritin and lymphocyte, were dependent on transfusion at diagnosis, had platelet counts below 100 × 109/L, hemoglobin levels below 8 g/dL, and were at high risk based on the dynamic international prognostic scoring system (DIPSS)-Plus. 

Read more about the prognosis of MF

Using statistical analysis, the researchers showed that age above 65 years, higher ferritin levels, low hemoglobin levels (below 8 g/dL), and being at high risk according to DIPSS-Plus score were associated with increased risk of death in MF. 

They also reported that the platelet-to-lymphocyte ratio and the SII index were lower in patients with a fatal outcome but [SII lost its relevance when . . . variables were incorporated into the multivariate Cox regression model]. No statistically significant link was found between the systemic inflammation response index and mortality.  

They concluded that unlike in other types of cancer, high SII and systemic inflammation response indices cannot be used as prognostic markers in MF.

“Since the pathology of MF directly involves the bone marrow unlike solid organ cancers, these inflammation markers may be insufficient to predict prognosis,” the researchers wrote. 


Ersal T, Özkocaman V, Pınar İE, et al. Systemic inflammatory indices for predicting prognosis of myelofibrosisSci Rep. 2023;13:12539. doi:10.1038/s41598-023-39077-7