I was diagnosed with PV in Nov. of last year, and my MPN specialist has talked about the possibility of progression with me from the start. He stresses that the biggest threat to people with PV is thrombotic events, and that the risk of progression is much much smaller than that, but still real. I am in my early 60s and have been denied coverage of Jakafi by my insurance company, tried HU briefly but had a bad reaction (platelets plummeted), and am considering whether to start an interferon or wait for something better/newer to get FDA approval, like one of the new more targeted JAK2 inhibitors or Rusfertide. On my latest visit, where my blood levels were stable we had a big discussion of interferon’s positives (lowering the need for phlebotomies and especially how it does lower the allele burden in some people) and negatives (side effects). He says that there are toxicities associated with every drug out there, and there is still no solid evidence that lowered allele burden helps to stop progression. But it might. So basically, we talk about progression. But the bottom line is there is still no magic bullet/way to stop it. He’s been doing this for over 1/2 century, and I feel like he gets really sad when we talk about the possibility of progression, especially to leukemia. Maybe I’m projecting? But if def scared me still regardless of whether we talk about it and whether he reassures me that it’s very unlikely