After sliding down the hill with MDS/MF for years, I finally reached a very critical point. I didn't want to go the route of Blood transfusions, because it just made me feel that was putting me on the leg of last resort. I will be 78 next month. CBC finally got so low that I was having a hard time just getting around without being so fatigued that I had to just sit down and try and recoup... which rarely happened. I finally gave in and had a Blood transfusing. Within hours, I felt better than I had felt in many years. It was a new lease on life. I continued getting transfusions, and of course, my CBC came way up. I felt great after each transfusion. As time went by the length of that exuberance decreased, and I started getting two bags. BANG right back up to the top. During this time, a new drug, Ojjaara, arrived on the scene. I started it, and within no time was off of all transfusions. My CBC has remained well above what it has been in over 10 years. That was over a year ago now. I am full of energy and resumed my old activities. Walk 2 mi every morning and attend an exercise class 3 times a week. I travel with my RV and life is good. It was the Blood transfusions that got me over the Hump and allow me to try this new drug. I can't say if you will have the same results, but what the heck... it doesn't look to me like you have a line-up of options. IMO, suck it up and get transfused!