Considering risk factors can help identify people with myelofibrosis who are the best candidates for splenectomy, according to a study involving 120 individuals (age median 66 years). Karyotype was abnormal in 60% and driver mutational status was JAK2 75%, CALR 15%, MPL 4%, and triple-negative 6%. Investigators looked at how risk factors impacted post-splenectomy survival. Among the results:

• At median follow-up of 1.3 years, nearly 80% died, and one-fourth experienced leukemic transformation.
• Median post-splenectomy survival was 1.5 years.
• Patients aged >65 years, as well as those with transfusion need, leukocyte count >25 x 10(9)/L, and circulating blasts ≥5% experienced worse survival.
• Median survival was 4 months in patients with 3 to 4 risk factors.
• Survival was 1.3 years in those with 2 risk factors, and nearly 3 years in those with 0 or 1 risk factor.
• Driver mutational status and leukemic transformation did not impact post-splenectomy survival.
• Very high-risk karyotype predicted leukemia-free survival.