@tlsorbet Thank you! That is a great recommendation. I will check it out. I have PMF with rare MPL and SRSF2 mutation. This combination means more fibrous issues in marrow and significant anemia. It’s also very slow to move to next stages like blasts, sweats, itching. My spleen is not at a size that I would start a Jakofi. According to the Transplant MD at the consulting center this is a good time to transplant because the spleen can impact the donor cell chimera. I appreciate your help. Thank you