▁they ▁have ▁a ▁heavy ▁requirement ▁for ▁blood ▁trans f us ions . ▁However , ▁spl en ect omy ▁in ▁the ▁presence ▁of ▁massive ▁spl en om eg aly ▁is ▁a ▁high - ris k ▁procedure , ▁with ▁a ▁mort ality ▁risk ▁as ▁high ▁as ▁ 3 % ▁in ▁some ▁studies . ▁ ▁In ▁November ▁ 2 0 1 1 , ▁the ▁F DA ▁approved ▁r ux olit in ib ▁( J ak af i ) ▁as ▁a ▁treatment ▁for ▁intermediate ▁or ▁high - ris k ▁my el of ib ros is . ▁R ux olit in ib ▁serves ▁as ▁an ▁in hib itor ▁of ▁J AK ▁ 1 ▁and ▁ 2 . ▁The ▁New ▁England ▁Journal ▁of ▁Medicine ▁( NE J M ) ▁published ▁results ▁from ▁two ▁Ph ase ▁III ▁studies ▁of ▁r ux olit in ib . ▁These ▁data ▁showed ▁that ▁the ▁treatment ▁significantly ▁reduced ▁s ple en ▁volume , ▁improved ▁sympt oms ▁of ▁my el of ib ros is , ▁and ▁was ▁associated ▁with ▁much ▁improved ▁overall ▁surv ival ▁rates ▁compared ▁to ▁place bo . ▁However , ▁the ▁benef icial ▁effect ▁of ▁r ux olit in ib ▁on ▁surv ival ▁has ▁been ▁recently ▁question ed . ▁ ▁In ▁August ▁ 2 0 1 9 , ▁the ▁F DA ▁approved ▁fed rat in ib ▁( IN RE B IC , ▁Imp act ▁bi om edic ines , ▁Inc .) ▁as ▁a ▁treatment ▁for ▁adult s ▁with ▁intermediate - 2 ▁or ▁high - ris k ▁primary ▁or ▁secondary ▁( post - poly cy