The use of age 60 as a risk factor is based on observations of people with MPNs over time. Note that the age of 65 is used in some protocols.

There are likely a number of reasons why age may matter. We accumulate additional mutations as we age, about 20-24 every year. We also develop additional medical conditions. Our risk for a variety of ailments increases. There are also cumulative changes in the bone marrow environment. It is also worth noting that everyone's risk of thrombosis increases as we age.

You would be correct to think that we all age differently and at different rates. The rate of aging has genetic drivers. We can also age better than people did in the past as the available medicine is better. That presumes one actually takes care of their health. As my MPN Specialist said to me "65 is the new 35." I liked that doc!

Given that age 60 is the most widely accepted criteria for the high-risk classification, most doctors are going to follow it. Most are unlikely to risk evaluating each patient's health for a more individualized recommendation. The need to practice defensive medicine is quite real and impacts what doctors are comfortable recommending.

Ultimately, it is up to you to determine whether age needs to be considered to be a risk factor in your specific case. It is your risk/benefit analysis that will determine when to initiate cytoreductive medications. It is very important to be clear about your treatment goals as well as what your risk tolerance is.

In my own case, I did not use age as a determining factor. I am also someone who appears younger than my +60 years and has a family history of longevity. I considered my overall health profile to be more relevant. My decision to use the interferons (Pegasys/Besremi) to treat the PV was driven by my 30+ years experience managing a MPN, prior history of treatment response, my risk tolerance/preferences, and my treatment goals (improve quality of life, reduce symptoms-adverse effects, reduce risk of progression as measured by reduction in JAK2 allele burden). Thus far, my choice has been successful. I feel better now than I did 10 years ago. My JAK2 VAF has reduced from 38% to 10%. I am very pleased by my response to my preferred treatment approach.

Wishing you all the best as you move forward.

Hi Mark,

We are quite different in our illness and most likely an individualised approach is better. Age is a risk factor, whether we like it or not, but applying it rigidly can result in someone younger who needs treatment being left untreated and someone above the age of 60 receiving treatment out of caution.
While longevity can be genetic, MPNs at older age are different than in someone younger, so we also need to have that aspect in mind when we consider treatment. A younger person will have the illness for longer time. If treatment means preserving better health in the long run, then that might be an option for someone who will have this illness for longer time, even if the person looks in good health or is below age 60. It is all a risk/benefit calculation. Genetic mutation matters, whether there are new mutations acquired over time, but also overall changes in health matter, and this is better to discuss with your hematologist.

Best wishes,
Tatiana

Four years ago I was diagnosed with PV at 61 yo. I was in what I thought was good health - no smoking, no other health problems. I discussed options with my doctor - hydroxyurea or aspirin and phlebotomy. I elected to go with aspirin and phlebotomy. It was a bit of a gamble. I had to have phlebotomies just about every month to try to keep my HCT below 45%. My WBC slowly crept up, as well as my immature granulocytes. My iron and ferritin went down. I had about 4 thrombophlebitis each year. I had a deep vein thrombosis in 2022. So, then I went on hydroxyurea. It took awhile, but it has helped to keep my numbers in near normal range and only 1 small thrombophlebitis. My RBC is still high. I am looking into Besremi, as my JAK2 allele burden is 67% - not a great indicator for progression. All that said you need to work with your MPN specialist to make the best medical decisions for you. While we all have PV or ET, our disease differs. Best wishes to you!

What a good question! I’m only 2 weeks into this so don’t have an answer for you but I’ll follow this thread with great interest! Best to you Mark — ❤️

60 is the magical number apparently. Seems so arbitrary, but that is what the science says. I wish i had a more satisfying answer. I am 44 and cant understand why I am not a risk until I am 60 or I have a stroke. Meanwhile, my platelets are 1,040 and my wbc is now rising too. 🤷‍♀️