Malnutrition and/or activation of catabolic pathways leading to hypoalbuminemia are probably not sufficient to explain the prognostic impact of albumin, since levels still in the lower range of normal represent an adverse risk factor not only in our cohort, but also according to all of the reports currently available on the prognostic role of albumin in MF [7,8,9]. This evidence concerns the gene ALB and malnutrition.