Primary myelofibrosis is aligned along a biological continuum from the early neoplastic stage—prefibrotic myelofibrosis–to the advanced metastatic myelofibrosis stage–“myelofibrosis with myeloid metaplasia” (MMM) [46], which is characterized by bone marrow failure with severe anemia and huge splenomegaly due to extramedullary hematopoiesis with seeding of CD34+ positive cells in the spleen, liver and elsewhere [1,47–48]. The gene discussed is CD34; the disease is Bone marrow hypocellularity.