Prognostic value of the inflammation-based prognostic scores and the red cell distribution width in patients with B large cell lymphoma

Uvod: B-velikostanični limfom (B-LCL, od engl. B large cells lymphoma) najčešći je ne- Hodgkinov limfom. Prognoza ovisi o kliničkim značajkama, sažetima u tzv. međunarodnom prognostičkom indeksu (IPI, od engl. international prognostic index). Molekulski i imunohistokemijski prognostički bilježi su ili nepouzdani ili njihova cijena i tehnička ograničenja čine rutinsku primjenu nepraktičnom. Stoga je pronalaženje surogatnih biljega, koji mogu poslužiti kao prognostički čimbenik, važan doprinos procjeni individalnog rizika. Cilj istraživanja: odrediti prognostički značaj upalnih prognostičkih bodovnih sustava i širine distribucije eritrocita (RDW, od engl. red blood cell distribution width) u bolesnika s B- LCL-om. Bolesnici i metode: Retrospektivno smo analizirali podatke 81 bolesnika s B-LCL-om koji su dijagnosticirani u razdoblju od 2006. do 2013. godine u KBC-u Osijek. Promatrani su ishodi, ukupno preživljenje (OS, od engl. overall survival) i preživljenje bez događaja (EFS, od engl. event free survival). Korištena je univarijatna i multivarijatna (Coxova regresijska) statistička analiza. Rezultati: Medijan dobi bolesnika bio je 64 godine, 29 ispitanika bili su muškarci (36 %). Vrijednost NLR-a (od engl. neutrophil lymphocyte ratio - omjer neutrofila i limfocita) bila je veća u bolesnika s proširenom bolesti (stadij III i IV) nego u onih s lokaliziranom bolesti (stadij I i II) (medijan [raspon] 3,12 [0,62 - 17,8] vs 2,38 [0,56 - 7,5], P = 0,037) i u onih bolesnika koji nisu odgovorili na terapiju (2,64 [0,56 - 11,29] vs 4 [0,62 - 14,17], P = 0,011). Vrijednost PLR-a (od engl. platelet lymphocyte ratio - omjer trombocita i limfocita) bila je veća u bolesnika s proširenom bolesti (stadij III i IV) nego u onih s lokaliziranom bolesti (stadij I i II) (181,18 [13,05 - 608,93] vs 132,24 [67,44 - 521,37], P = 0,023), a nije bilo statistički značajne razlike u vrijednosti PLR-a između bolesnika koji su odgovorili na terapiju i onih koji nisu (P=0,151). Bolesnici s višim vrijednostima GPS-a bili su lošijeg općeg stanja (P = 0.002), većeg kliničkog stadija po Ann Arboru (P = 0.03) i imali su lošiji odgovor na terapiju (P 2,63 (rezna vrijednost izračunata ROC, od engl. receiver operating characteristic, analizom) (65,8 % vs 86,6 % za dvogodišnji OS, P = 0,007; 58,2 % vs 86,6 % za dvogodišnji EFS, P = 0,001) i u bolesnika s RDW > 15 % (rezna vrijednost izračunata ROC analizom) (42,2 % vs 91,7 % za dvogodišnji OS, P 15 % bio neovisan prognostički čimbenik za OS (HR, od engl. hasard ratio - omjer rizika, 8,873, 95 % CI, od engl. confidence interval - interval pouzdanosti, 2,065-38,132, P = 0,003) i EFS (HR 5,755, 95 % CI 1,733-19,11, P = 0.004), dok je NLR bio prognostički značajan samo za EFS (HR 5,973, 95 % CI 1,832-19,481, P = 0,003). Zaključak: U bolesnika s B-LCL-om naše je istraživanje potvrdilo NLR kao koristan prognostički biljeg, dok PLR i GPS nisu pokazali neovisnu prognostičku vrijednost za preživljenje. Visoka početna vrijednost RDW-a bila je povezana s lošijim ishodom. RDW bi mogao biti lako dostupan, jeftin prognostički biljeg za stratifikaciju bolesnika u rizične skupine.Background: B-large cell lymphoma (B-LCL) is the most common non-Hodgkin's lymphoma. The prognosis depends primarily on clinical features, summarized in the so-called International Prognostic Index (IPI). There are certain molecular and immunohistochemical prognostic markers in patients with B-LCL, but their cost and technical constraints make such an application in routine impractical and expensive. Therefore, finding surrogate markers that may serve as a prognostic factor is an important contribution to the establishment of individual risk assessment. Objectives: The aim of this study was to analyze the prognostic significance of inflammation based prognostic scores and red blood cell distribution width (RDW) in B-LCL patients. Patients and methods: We retrospectively analyzed data from 81 B-LCL patients diagnosed from 2006 to 2013 at the University Hospital Center Osijek, Osijek, Croatia. We evaluated disease outcome, overall survival (OS) and event-free survival (EFS), and demographic, clinical and laboratory factors affecting outcome. Univariate analysis and Cox regression analysis were used. Results: The median age of patients was 64 years, 29 were men (35.8 %). Higher neutrophil to lymphocyte ratio (NLR) was found in patients with an advanced disase (median [range] 3.12 [0.62 - 17.8] vs 2.38 [0.56 - 7.5], P = 0.037 and a poorer response to therapy (median [range] 2.64 [0.56 - 11.29] vs 4 [0.62 - 14.17], P = 0.011). Higher platelet to lymphocyte ratio (PLR) was found in patients with an advanced disase (median [range] 181,18 [13,05 - 608,93] vs 132,24 [67,44 - 521,37], P = 0,023), values of PLR were not significant for response to treatment. Patients with higher GPS were in poorer general condition (P = 0.002), advanced disease stage (P = 0.03), and a poorer response to therapy (P 2.63 (cutoff value calculated by receiver-operating characteristic) had a significantly worse two-year OS (65.8 % vs 86.6 %, P = 0.007) and two-year EFS (58.2 % vs 86.6 %, P = 0.001). PLR values were not significant for survival. The two-year OS rates for patients with Glasgow prognostic score (GPS) = 0, GPS = 1, and GPS = 2 were 89.6 %, 65.8 % and 36.4 % (P = 0.002) and EFS rates were 81.6 %, 63.2 %, and 36.4 %, respectively (P = 0.014). Patients with RDW>15 % (cut-off was calculated by receiver operating characteristics) had a significantly worse two-year OS (42.2 % vs 91.7 %, P 15 % was an independent prognostic factor for OS (hazard ratio [HR] 8.873, 95 % confidence interval [CI] 2.065-38.132, P = 0.003) and EFS (HR 5.755, 95 % CI 1.733-19.11, P = 0.004) while NLR values of > 2.63 were an independent prognostic factor only for EFS (HR 5.973, 95 % CI 1.832-19.481, P = 0.003) Conclusion: Our research confirmed NLR as a useful independent prognostic marker for survival. PLR and GPS did not show an independent prognostic value. High baseline RDW is an independent prognostic marker of poor outcome in patients with DLBCL. RDW could be an easily available and inexpensive marker for the risk stratification in patients with B-LCL

Red blood cell distribution width as a simple negative prognostic factor in patients with diffuse large B-cell lymphoma: a retrospective study

Aim To determine the prognostic value of baseline red blood cell distribution width (RDW) in diffuse large B cell lymphoma (DLBCL) patients. Methods Data from 81 DLBCL patients diagnosed from 2006 to 2013 at the University Hospital Center Osijek, Osijek, Croatia, were reviewed. We evaluated disease outcome, overall survival (OS) and event-free survival (EFS), and demographic, clinical and laboratory factors affecting outcome. Univariate analysis and Cox regression analysis were used. Results Median age of patients was 64 years, 29 were men (35.8%). Higher RDW levels (%) were found in patients with advanced Ann Arbor clinical stage (14.94 ± 1.82 vs 13.55 ± 1.54, P = 0.001) and in those with poor response to therapy (14.94 ± 1.82 vs 13.55 ± 1.54, P = 0.001). Patients with RDW>15% (cut-off was calculated by receiver operating characteristics) had significantly worse OS (median [range], 33 months [20-46] vs 74 months [65-82], P < 0.001) and EFS (27 months [15-40] vs 68 months [59-77], P < 0.001). Cox regression analysis showed that RDW>15% was an independent prognostic factor for OS (HR 3.654, 95% CI 1.128-11.836) and EFS (HR 2.611, 95% CI 1.012-6-739). Conclusion High baseline RDW is an independent prognostic marker of poor outcome in patients with DLBCL. RDW could be an easily available and inexpensive marker for the risk stratification in patients with DLBCL

Survival in Dialysis or Plasma Exchange Treated Patients for Multiple Myeloma – A Single Centre 25 Year Experience

Aim: Multiple myeloma (MM) patients might require haemodialysis (HD) and/or plasma exchange (PE) in cases of acute kidney injury (AKI) and/or chronic kidney disease (CKD) and/or other indications. The study analysed the survival of MM patients who required HD and/or PE. Subjects and methods: All 144 patients treated for MM at the University Hospital Centre Osijek between 1994 and 2018 (of whom 47.9 % were men) were included in the study. Data were collected from medical records. MedCalc Statistical Software version 17.8.2 was used for the statistical analysis, with significance set at α = 0.05. Results: Forty-three of 144 MM patients (29.9 %) were treated with HD and/or PE. Male patients required HD or PE more often than female patients (62.8 % vs 37.2 %, P = 0.02). Patients who did not require HD or PE were significantly older at the time of their death than the patients treated with HD or PE [75 (interquartile range, IQR, 72 – 77) vs 72 (IQR 66 – 75) years; P = 0.009, Mann-Whitney test]. Among all patients who required acute or chronic HD, PE or a combination of the treatments, the longest life span was found in 17 patients who were treated with chronic HD (median 12 months, IQR 8 – 58). Conclusion: Kidney failure requiring HD or PE in MM was associated with a significantly shorter life span in comparison with other MM patients. Chronic HD patients had the longest survival among patients who required acute or chronic HD, PE or a combination of the treatments. In general, MM patients in need for HD and/or PE had poor survival. (Smajić* P, Schönberger E, Periša V, Sinčić Petričević J, Zibar L, Kralik K. Survival of Multiple Myeloma Patients Undergoing Dialysis or Plasma Exchange - A Single Centre’s 25-Year Experience. SEEMEDJ 2020; 4(1); 25-31

Use of bendamustin instead of carmustin in autologous stem cell transplantation conditioning – toxicity and infectious complications comparison

Unatrag nekoliko godina u hematologiji i onkologiji globalno sve češći problem postaje prikladna opskrba „starijim i manje zanimljivim“ kemoterapeuticima. Zbog povremene nestašice karmustina, jednog od osnovnih kemoterapeutika pri kondicioniranju prije autologne transplantacije krvotvornih matičnih stanica (ATK S) u oboljelih od limfoma, u našem se centru od 2016. godine on zamjenjuje bendamustinom. U ovom radu retrospektivno analiziramo tijek ATK S-a u 41 bolesnika koji su primili bendamustin u sklopu protokola BeEA M te ga uspoređujemo s tijekom ATK S-a u 40 bolesnika koji su primili karmustin u sklopu protokola BEA M. Medijan oporavka vrijednosti neutrofila (> 0,5 × 109/l) u skupini koja je primila bendamustin iznosio je 11 dana, dok je u skupini kondicioniranoj karmustinom iznosio 10 dana. Medijan oporavka vrijednosti trombocita (> 20 × 109/l) bio je duži kod skupine koja je primala bendamustin (16 prema 13 dana) te su ti bolesnici bili duže ovisni o transfuzijama eritrocita (7 prema 5 dana). Infektivne komplikacije nisu bile češće nakon primjene bendamustina, ali smo nakon primjene karmustina imali veću pojavu mukozitisa II. – III. stupnja (35% prema 12%). Nakon primjene bendamustina zabilježen je jedan slučaj nefrotoksičnosti i kardiotoksičnosti terapije, dok kod primjene karmustina te komplikacije nisu zabilježene. Pri upotrebi bendamustina kod kondicioniranja u naših bolesnika u ovom trenutku nije utvrđena znatnija hematološka toksičnost u odnosu prema karmustinu, ali su prisutni dulji period oporavka vrijednosti trombocita te niža incidencija mukozitisa.Inadequate supply of „old and less interesting“ chemotherapeutic agents is becoming a global issue in hemato-oncology today. In 2016 we were faced with occasional carmustin shortage, one of the most commonly used in autologous transplant conditioning regimens for lymphoma in our centre, so we decided to use bendamustin instead. We performed a retrospective analysis of 41 patients treated at our centre who had received bendamustin within BeEA M protocol and compared them with 40 patients who had received carmustin within BEA M protocol. Both protocols were used as conditioning protocols before autologous stem cell transplantation. Neutrophil recovery median following transplantation (AN C>0,5x109/l) was 11 days in the bendamustin group in comparison to 10 days in the carmustin group.Platelets recovery median following transplantation (PLT>20x109/l) was longer in the bendamustin group (16 vs.13 days) as was blood transfusion dependency (7 vs. 5 days). Infectious complications were not more frequent after bendamustin, but grade II–III mucositis was more frequent in patients who received carmustin (35% vs.12%). Following bendamustin we had one reported case of nephrotoxicity and cardiac toxicity, not reported with carmustin. Bendamustin has shown similar hematologic toxicity compared to carmustin but a longer platelet recovery period and a lower mucositis incidence

Prognostic value of the inflammation-based prognostic scores and the red cell distribution width in patients with B large cell lymphoma

Uvod: B-velikostanični limfom (B-LCL, od engl. B large cells lymphoma) najčešći je ne- Hodgkinov limfom. Prognoza ovisi o kliničkim značajkama, sažetima u tzv. međunarodnom prognostičkom indeksu (IPI, od engl. international prognostic index). Molekulski i imunohistokemijski prognostički bilježi su ili nepouzdani ili njihova cijena i tehnička ograničenja čine rutinsku primjenu nepraktičnom. Stoga je pronalaženje surogatnih biljega, koji mogu poslužiti kao prognostički čimbenik, važan doprinos procjeni individalnog rizika. Cilj istraživanja: odrediti prognostički značaj upalnih prognostičkih bodovnih sustava i širine distribucije eritrocita (RDW, od engl. red blood cell distribution width) u bolesnika s B- LCL-om. Bolesnici i metode: Retrospektivno smo analizirali podatke 81 bolesnika s B-LCL-om koji su dijagnosticirani u razdoblju od 2006. do 2013. godine u KBC-u Osijek. Promatrani su ishodi, ukupno preživljenje (OS, od engl. overall survival) i preživljenje bez događaja (EFS, od engl. event free survival). Korištena je univarijatna i multivarijatna (Coxova regresijska) statistička analiza. Rezultati: Medijan dobi bolesnika bio je 64 godine, 29 ispitanika bili su muškarci (36 %). Vrijednost NLR-a (od engl. neutrophil lymphocyte ratio - omjer neutrofila i limfocita) bila je veća u bolesnika s proširenom bolesti (stadij III i IV) nego u onih s lokaliziranom bolesti (stadij I i II) (medijan [raspon] 3,12 [0,62 - 17,8] vs 2,38 [0,56 - 7,5], P = 0,037) i u onih bolesnika koji nisu odgovorili na terapiju (2,64 [0,56 - 11,29] vs 4 [0,62 - 14,17], P = 0,011). Vrijednost PLR-a (od engl. platelet lymphocyte ratio - omjer trombocita i limfocita) bila je veća u bolesnika s proširenom bolesti (stadij III i IV) nego u onih s lokaliziranom bolesti (stadij I i II) (181,18 [13,05 - 608,93] vs 132,24 [67,44 - 521,37], P = 0,023), a nije bilo statistički značajne razlike u vrijednosti PLR-a između bolesnika koji su odgovorili na terapiju i onih koji nisu (P=0,151). Bolesnici s višim vrijednostima GPS-a bili su lošijeg općeg stanja (P = 0.002), većeg kliničkog stadija po Ann Arboru (P = 0.03) i imali su lošiji odgovor na terapiju (P 2,63 (rezna vrijednost izračunata ROC, od engl. receiver operating characteristic, analizom) (65,8 % vs 86,6 % za dvogodišnji OS, P = 0,007; 58,2 % vs 86,6 % za dvogodišnji EFS, P = 0,001) i u bolesnika s RDW > 15 % (rezna vrijednost izračunata ROC analizom) (42,2 % vs 91,7 % za dvogodišnji OS, P 15 % bio neovisan prognostički čimbenik za OS (HR, od engl. hasard ratio - omjer rizika, 8,873, 95 % CI, od engl. confidence interval - interval pouzdanosti, 2,065-38,132, P = 0,003) i EFS (HR 5,755, 95 % CI 1,733-19,11, P = 0.004), dok je NLR bio prognostički značajan samo za EFS (HR 5,973, 95 % CI 1,832-19,481, P = 0,003). Zaključak: U bolesnika s B-LCL-om naše je istraživanje potvrdilo NLR kao koristan prognostički biljeg, dok PLR i GPS nisu pokazali neovisnu prognostičku vrijednost za preživljenje. Visoka početna vrijednost RDW-a bila je povezana s lošijim ishodom. RDW bi mogao biti lako dostupan, jeftin prognostički biljeg za stratifikaciju bolesnika u rizične skupine.Background: B-large cell lymphoma (B-LCL) is the most common non-Hodgkin's lymphoma. The prognosis depends primarily on clinical features, summarized in the so-called International Prognostic Index (IPI). There are certain molecular and immunohistochemical prognostic markers in patients with B-LCL, but their cost and technical constraints make such an application in routine impractical and expensive. Therefore, finding surrogate markers that may serve as a prognostic factor is an important contribution to the establishment of individual risk assessment. Objectives: The aim of this study was to analyze the prognostic significance of inflammation based prognostic scores and red blood cell distribution width (RDW) in B-LCL patients. Patients and methods: We retrospectively analyzed data from 81 B-LCL patients diagnosed from 2006 to 2013 at the University Hospital Center Osijek, Osijek, Croatia. We evaluated disease outcome, overall survival (OS) and event-free survival (EFS), and demographic, clinical and laboratory factors affecting outcome. Univariate analysis and Cox regression analysis were used. Results: The median age of patients was 64 years, 29 were men (35.8 %). Higher neutrophil to lymphocyte ratio (NLR) was found in patients with an advanced disase (median [range] 3.12 [0.62 - 17.8] vs 2.38 [0.56 - 7.5], P = 0.037 and a poorer response to therapy (median [range] 2.64 [0.56 - 11.29] vs 4 [0.62 - 14.17], P = 0.011). Higher platelet to lymphocyte ratio (PLR) was found in patients with an advanced disase (median [range] 181,18 [13,05 - 608,93] vs 132,24 [67,44 - 521,37], P = 0,023), values of PLR were not significant for response to treatment. Patients with higher GPS were in poorer general condition (P = 0.002), advanced disease stage (P = 0.03), and a poorer response to therapy (P 2.63 (cutoff value calculated by receiver-operating characteristic) had a significantly worse two-year OS (65.8 % vs 86.6 %, P = 0.007) and two-year EFS (58.2 % vs 86.6 %, P = 0.001). PLR values were not significant for survival. The two-year OS rates for patients with Glasgow prognostic score (GPS) = 0, GPS = 1, and GPS = 2 were 89.6 %, 65.8 % and 36.4 % (P = 0.002) and EFS rates were 81.6 %, 63.2 %, and 36.4 %, respectively (P = 0.014). Patients with RDW>15 % (cut-off was calculated by receiver operating characteristics) had a significantly worse two-year OS (42.2 % vs 91.7 %, P 15 % was an independent prognostic factor for OS (hazard ratio [HR] 8.873, 95 % confidence interval [CI] 2.065-38.132, P = 0.003) and EFS (HR 5.755, 95 % CI 1.733-19.11, P = 0.004) while NLR values of > 2.63 were an independent prognostic factor only for EFS (HR 5.973, 95 % CI 1.832-19.481, P = 0.003) Conclusion: Our research confirmed NLR as a useful independent prognostic marker for survival. PLR and GPS did not show an independent prognostic value. High baseline RDW is an independent prognostic marker of poor outcome in patients with DLBCL. RDW could be an easily available and inexpensive marker for the risk stratification in patients with B-LCL

Prognostic Nutritional Index as a Predictor of Prognosis in Patients with Diffuse Large B cell Lymphoma

BACKGROUND: The prognostic nutritional index (PNI), an indicator of nutritional status and systemic inflammation, is associated with short-term and long-term outcomes of various malignancies. The prognostic value of PNI in diffuse large B cell lymphoma (DLBCL) remains unknown. The aim of the present study was to determine the prognostic value of baseline PNI in DLBCL patients. METHODS: We retrospectively analyzed data from 103 DLBCL patients treated with R‑CHOP or R‑CHOP-like regimens. We evaluated the significance of PNI as a predictor of response to treatment, overall survival (OS) and event-free survival (EFS). RESULTS: Patients with a PNI ≤ 44.55, where the cut-off was calculated by receiver operating characteristics (Youden index) and the same was obtained for response to treatment with 76.2 % sensitivity and a specificity of 85.4 %, for OS with 72.4 % sensitivity and a specificity of 90.5 % and for EFS with 65.6 % sensitivity and a specificity of 90.1 %, had significantly worse 5‑year OS (18.3 % vs 86.4 %, P < 0.001, log rank test) and 5‑year EFS (15.1 % vs 82.3 %, P < 0.001, log rank test). Regression analysis showed that PNI ≤ 44.55 was an independent prognostic factor for response to treatment with an odds ratio (OR) of 4.88 for treatment failure, 95 % confidence interval (CI) 1.077-22.105, OS hazard ratio (HR) 4.24, 95 % CI 1.451-12.392 and EFS HR 4.007, 95 % CI 1.48-10.852. Lower PNI levels were found in patients with advanced Ann Arbor clinical stage (46.6 ± 7.77 vs. 52.7 ± 5.43) and in those with poor response to therapy (40.58 ± 7.26 vs. 50.67 ± 6.26). CONCLUSIONS: The PNI is a simple and useful marker to predict long-term survival outcome in DLBCL patients. Low PNI predicted poor outcome. A limitation of the study is its retrospective design in which the prognostic value was tested in the derivation cohort only. Notwithstanding, this is the first study suggesting that PNI is an important prognostic factor in DLBCL

Comparison of the Prognostic Impact of Neutrophil/Lymphocyte Ratio, Platelet/Lymphocyte Ratio, and Glasgow Prognostic Score in Diffuse Large B-Cell Lymphoma

Background: Given the role of inflammation in tumor progression, as well as in diffuse large B-cell lymphoma (DLBCL), researchers are trying to identify easily applicable, easy accessible prognostic markers for individual risk assessment. The most frequently used inflammatory prognostic markers are the neutrophil-to-lymphocyte ratio (NLR), the platelet-to-lymphocyte ratio (PLR),andthe Glasgow prognostic score (GPS). Objectives: To determine and compare the prognostic value of the baseline inflammatory biomarkers NLR, PLR, and GPS in patients with DLBCL. Methods: We retrospectively analyzed data from 103 DLBCL patients treated with R-CHOP or R-CHOP-like regimens. We evaluated the significance of NLR, PLR, and GPS as a predictor of response to treatment, overall survival (OS), and event-free survival (EFS). Results: Higher NLR levels were found in patients with a poorer response to therapy (median [range] 2.87 [0.56 - 26.33] vs. 4 [0.62 - 29.66], P = 0.026). Patients with NLR values of > 2.63 (cutoff value calculated by receiver-operating characteristic) had significantly worse two-year OS (65.1% vs. 87.2%, P = 0.002) and two-year EFS (59.8% vs. 87.1%, P = 0.001). PLR values were not significant for survival. The two-year OS rates for patients with GPS = 0, GPS = 1, and GPS = 2 were 93.3%, 63.9%, and 33.3%, respectively (P 2.63 were an independent prognostic factor for OS (hazard ratio [HR] = 2.857; 95% confidence interval [CI] 1.022 - 8.699; P = 0.048] and EFS (HR = 4.06; 95% CI 1.357 - 12.151; P = 0.012). Conclusions: Our research confirmed NLR as useful independent prognostic marker for survival. PLR and GPS did not show independent prognostic value, although they were also associated with the patients’ clinical features. The easy availability and inexpensiveness of inflammatory biomarkers should encourage their use in clinical practice

MPN-541 Estimated Plasma Volume Status in Patients With Primary Myelofibrosis and Associated Thrombotic and Mortality Risks

Context: Blood plasma experiences substantial changes in both volume and composition in patients with chronic myeloproliferative neoplasms (MPN) and represents a large reservoir of cytokines and other mediators of inflammation. Higher estimated plasma volume status (ePVS) has recently been shown to correlate with increased thrombotic risk in polycythemia vera patients. Objective: To estimate clinical and prognostic associations of ePVS in patients with myelofibrosis. Design: Retrospective cohort study. Setting: 6 hematology centers. Patients: 238 myelofibrosis patients, 168 with PMF, 34 with post-PV SMF and 36 with post-ET SMF. Interventions: ePVS was calculated using the Strauss derived Duarte formula: (100-hematocrit (%)/hemoglobin (g/dL) and expressed as dl/g. Main outcome measures: Overall survival (OS) and time to thrombosis (TTT). Results: Median ePVS was 5.8 dl/g and it did not significantly differ between PMF and SMF patients. Among other associations, higher ePVS was significantly associated with higher degree of bone-marrow fibrosis, absence of JAK2-mutation, lower white blood cells (WBC), platelets and hemoglobin, presence of circulatory blasts, higher C-reactive protein, higher lactate dehydrogenase, lower albumin and higher Charlson comorbidity index in an overall cohort, as well as with more pronounced splenomegaly and higher Dynamic International Prognostic Scoring System (DIPSS) risk in primary myelofibrosis (PMF) and higher Mysec-PM risk in secondary myelofibrosis (SMF) patients (P5.6 dl/g) was associated with shorter overall-survival (OS) in PMF (HR=2.8, P7 dl/g, HR=4.1, P=0.009) patients. Associations with overall survival diminished in multivariate analyses after adjustments for DIPSS and Mysec-PM, respectively. Association with TTT remained significant independently of JAK2, WBC and chronic kidney disease. Conclusions: Myelofibrosis patients with more advanced disease features and more pronounced inflammation have higher ePVS, indicative of expanded plasma volume. Higher ePVS is associated with impaired survival in PMF and SMF and higher thrombotic risk in PMF patients