CRP/Albumin Ratio and Glasgow Prognostic Score Provide Prognostic Information in Myelofibrosis Independently of MIPSS70—A Retrospective Study

Round 1

Reviewer 1 Report

In their retrospective study the authors showed that the measurement of routine laboratory markers such as C-reactive Protein and albumin at time of diagnosis provides prognostic information independently from the prognostic scoring system that includes the molecular profile of patients with myelofibrosis. The study is well designed and the results are supported by the appropriate statistics. In my opinion, due the clinical application of these results, the manuscript is worth to be published.   

Author Response

Thank you for this thoughtful summary of the manuscript and favorable comments

Reviewer 2 Report

The authors provide a single institution evaluation of patient serum CRP and albumin levels in conjunction with Glasgow scores to offer prognostication in myelofibrosis.

Major

1. The introduction needs to be expanded upon namely to explain why the MIPPS70 and not the DIPSS or DIPSS+ was chosen.  The advantage of the present study is that CRP and albumin are readily available inexpensive tests and the Glasgow score can be easily calculated. Therefore the benefit of this study is that it offers a potential prognostic system that can be applied easily throughout the world and does not require molecular data. 

2. In regards to myelofibrosis there are different prognostic scores for primary myelofibrosis (DIPSS and DIPSS+, MIPSS70) and secondary myelofibrosis (MYSEC-PM). I would either remove the secondary MF patients or use the MYSEC-PM for analysis in these pts. 

3. As per previously reported literature (Lucijanic et al) the CAR was calculated using a CRP of 10 mg/L and albumin of <35 g/L. I would recommend that these cutoffs also be used for the dichotomous cut offs seen in Table 2 since these have previously been studied and what the CAR is based off of. 

Minor

1. What is meant by "manifest myelofibrosis"? I am not familiar with this term. 

Author Response

Please see attachment

Author Response File: Author Response.pdf

Round 2

Reviewer 2 Report

I would recommend that the analysis be done for PMF and SMF separately then combined together given the lack of published validity of the MIPSS70 with SMF. It is hard for me to move away from the lack of data for evaluation of a model used in this study on 20% of patients. 

Author Response

Response to Reviewer 2:

I would recommend that the analysis be done for PMF and SMF separately then combined together given the lack of published validity of the MIPSS70 with SMF. It is hard for me to move away from the lack of data for evaluation of a model used in this study on 20% of patients. 

 

Response: As per the Reviewer’s suggestion, we have performed two additional separate analysis of the cases with PMF and SMF.

With regard to PMF, applying the same threshold that had been used for all MF cases, CAR (>0.374) and GPS (>0) retained additional prognostic value, despite the limited number of cases evaluable (n=35). We have integrated these results into the revised manuscript (see page 6) and have provided an additional Table 3 (see page 7).

With regard to the cases of SMF, the low number of cases for whom both CRP and albumin were  available (n=12) precluded a meaningful analysis. (Please see the Table below: ‘’ for Reviewers only’’).

Author Response File: Author Response.pdf

Round 3

Reviewer 2 Report

The authors have sufficiently answered my questions.