Considering long-term adverse effects, a single-center, long-term follow-up study found that TPO-R agonists (romiplostim, eltrombopag, and/or avatrombopag) induce myelofibrosis grades 2/3 in about 20% of patients with immune thrombocytopenia, particularly with more than 2 years of treatment. The gene discussed is MPL; the disease is myelofibrosis.