Your doctor looks at a few simple things that strongly influence outlook:

• Age at diagnosis. Younger people generally do better over time [2][4].
• History of blood clots. Clots (stroke, heart attack, DVT/PE) are a leading cause of illness in PV, so preventing them is key [5][6][7][8].
• Symptoms and blood counts. Very high counts or persistent symptoms can signal a higher risk [5].
• Diseases change over time. Some patients later develop post-PV myelofibrosis (scarred bone marrow with low counts) or, less commonly, acute leukemia—both events lower survival [1].

• A modern, international study of ~1,545 patients reported a median overall survival of ~14 years, with substantially longer survival in younger patients [1].
• Another large dataset, comprising ~1,263 patients, showed similar patterns—age and risk factors had a strong influence on survival [2].
• An earlier clinical series also found that life expectancy is reduced compared to the general population. However, many people still live decades after diagnosis, particularly when diagnosed before age 60 and treated to prevent clots [3].

Note: Many people with PV live a long time. The numbers above are averages; your path will depend on your age, health, and how well treatment controls the risk.

Doctors may use risk models (simple scoring tools) to estimate outlook and guide follow-up:

• Dynamic prognostic model (after PV changes to myelofibrosis). This model updates risk as labs and symptoms change, helping tailor care over time [4].
• Clinical-molecular model (for post-PV or post-ET myelofibrosis). This adds genetic information (molecular markers) to clinical features to predict survival more precisely once myelofibrosis develops [6].

Myelofibrosis = scarring of the bone marrow that can lead to anemia (low red cells), low platelets, a big spleen, night sweats, and weight loss.

Care that lowers clot risk and controls blood counts is central:

• Phlebotomy (blood removal) and low-dose antiplatelet are standard treatments to maintain a safe hematocrit level (the percentage of blood that is red blood cells) and reduce the risk of clotting [7].
• Cytoreductive therapy (medications that lower counts), such as interferon therapy, is used for higher-risk patients (for example, those with older age or a prior history of clotting) to reduce complications further [5].
• Treatment choices and timing are guided by simple groups based on your chance of developing blood clots (for clot risk) in routine PV and by specialized models if the disease later becomes myelofibrosis [4][7].

Note: Maintaining controlled counts and preventing clots can help you live longer and feel better with PV.

PV can stay stable for many years. A smaller group of patients will develop:

• Post-PV myelofibrosis (scarred bone marrow, low counts, big spleen). Prognosis then depends on the new risk score tailored for myelofibrosis [4][6].

Acute leukemia (sudden, aggressive blood cancer). This is less common but carries a poorer outlook, which is why regular follow-up is essential to catch changes early [5].

• Stick to follow-up. Regular check-ups and blood tests help your team adjust treatment early.
• Know your hematocrit goal. Many treatment plans aim to keep the hematocrit under ~45% to lower the risk of clotting (your doctor will confirm your target) [7].
• Manage heart-health risks. Control blood pressure, cholesterol, and diabetes, and avoid smoking to reduce the risk of blood clots [5].
• Report changes. New headaches, chest pain, shortness of breath, leg swelling, night sweats, weight loss, or a rapidly enlarging spleen should be reviewed immediately.

1. What is the average life expectancy with PV?

Large studies report median survival ~14 years overall, with younger patients often surpassing 20 years when care is consistent [1]. Other big series show similar patterns and better outcomes in younger/lower-risk groups [2][3].

2. What most affects my prognosis?

Age, history of clots, blood counts/symptoms, and whether PV later changes to myelofibrosis or leukemia are key drivers [1] [5].

3. Can treatment improve my outlook?

Yes, phlebotomy and low-dose antiplatelet, combined with cytoreductive therapy, are beneficial for higher-risk patients, reducing the risk of clots and complications, which supports more prolonged survival [7].

4. What if my PV becomes myelofibrosis?

Doctors switch to myelofibrosis-specific risk tools (dynamic and clinical-molecular models) to guide treatment and estimate outlook based on updated labs, symptoms, and genetics [4][6].

5. Why are regular visits so important?

PV can change slowly. Monitoring helps keep hematocrit in range, prevents clots, and catches changes early, which can protect your long-term health [7].

1. Tefferi A, Rumi E, Finazzi G, et al. Survival and prognosis among 1545 patients with contemporary polycythemia vera: an international study. Leukemia. 2013;27(9):1874-1881.
2. Tefferi A, Rumi E, Finazzi G, et al. Survival and prognosis among 1,263 patients with polycythemia vera: an international study. Blood. 2011;118(21):277.
3. Passamonti F, Rumi E, Pungolino E, et al. Life expectancy and prognostic factors for survival in PV and ET. Am J Med. 2004;117(10):755-761.
4. Passamonti F, Rumi E, Caramella M, et al. A dynamic prognostic model to predict survival in post-PV myelofibrosis. Blood. 2008;111(7):3383-3387.
5. Tefferi A, Vannucchi AM, Barbui T. Polycythemia vera: historical oversights, diagnostic details, and therapeutic views. Leukemia. 2021;35(12):3339-3351.
6. Passamonti F, Giorgino T, Mora B, et al. A clinical-molecular prognostic model in post-PV and post-ET myelofibrosis. Leukemia. 2017;31(12):2726-2731.
7. Tefferi A, Vannucchi AM, Barbui T. Polycythemia vera treatment algorithm 2018. Blood Cancer J. 2018;8(1):3.
8. Pearson TC, Messinezy M, Westwood N, et al. A PV update: diagnosis, pathobiology, and treatment. ASH Education Program Book. 2000;2000(1):51-68.