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During an MPN Hub symposium presented at the European School of Haematology (ESH) 4th How to Diagnose and Treat: CML/MPN conference, MPN Hub steering committee Chair Jean-Jacques Kiladjian, Université Paris Cité and Hôpital Saint-Louis, Paris, FR, presented a review of anemia in myelofibrosis (MF), with a focus on the impact of anemia on patient outcomes.

Key points

MF is associated with a range of clinical manifestations and constitutional symptoms, including anemia, that significantly impact patient outcomes.
The cause of anemia in MF is multifactorial, including splenomegaly-induced hemodilution and increases in plasma volume, red blood cell sequestration and destruction, and ineffective erythropoiesis; it can also be caused or exacerbated by certain MF treatments.
Anemia is prevalent in patients with MF, with ~40% of patients anemic at diagnosis and ~25% of patients transfusion dependent at diagnosis, rising to almost 60% and 50% respectively within the first year of diagnosis and increasing further over time. It is often severe (defined as <8g/dL hemoglobin or transfusion dependence).
Anemia is included in all MF prognostic scoring systems, and both anemia severity and transfusion dependence are strongly predictive of reduced QoL and survival outcomes in patients with anemia.

- Anemia and increasing severity of anemia significantly reduce OS for patients with MF.

- The median OS in transfusion-independent patients is ~62 months, and only ~22 months in highly transfusion-dependent patients.

- Transfusion burden can impact employment and social life.

Improving anemia is an important goal alongside targeting spleen size and symptoms for improving everyday QoL and long-term outcomes in patients with MF.

- Anemia therefore represents an important consideration for treatment decision-making.

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