OBJECTIVES: To compare incidence of myelofibrosis (MF)-related complications and all-cause and MF-related resource utilization (RU) in blood transfusion-dependent (TD) MF patients treated with vs. without iron-chelating therapy (ICT+ vs. ICT-).   METHODS: Two commercial healthcare claims databases, Truven MarketScan (2000-2012) and PharMetrics (2001-2012), were analyzed. Patients with ≥2 MF ICD-9 diagnosis codes ≥30 days apart and ≥18 years at first MF diagnosis were included. First evidence of TD (index date) was defined as ≥3 transfusion events within any 3-month period. Adjusted incidence rate ratios (aIRRs) of MF-related complications and all-cause and MF-related RU in TD ICT+ vs. ICT- patients were assessed using Poisson regressions, controlling for baseline comorbidities and MF-related complications.  RESULTS: Of the 571 eligible TD MF patients, 103 (18%) were ICT+ and 468 (82%) were ICT-. Mean age was similar between groups (ICT+: 67.2[SD: 10.4] vs. ICT-: 66.6[11.7]). Mean observation time was longer for ICT+ patients (months, 22.2[13.9] vs. 12.6[11.6]). ICT- patients had higher mean Charlson Comorbidity Index (1.8[1.8] vs. 2.3[2.1]), suggesting a greater burden of comorbidities. Mean number of transfusion events/year was similar between groups (22.4[19.5] vs. 22.2[28.5]; p=0.94). ICT+ patients had lower rates of thrombocytopenia (aIRR: 0.54; p<.001) and pancytopenia (0.53; p<.001).  Rates of other MF-related complications were similar between groups.  ICT+ patients had significantly lower rates of all-cause and MF-related ER visits (all-cause aIRR: 0.83 [95% CI: 0.72-0.95]) as well as inpatient stays (0.75 [0.64-0.87]) and days (0.52 [0.50-0.55]), but higher rates of outpatient visits (1.22 [1.19-1.25]).  CONCLUSIONS: Despite similar complication profiles, ICT+ patients had significantly lower rates of acute care, but higher rates of outpatient care vs. ICT- patients, suggesting a possible link between closer monitoring and decreased acute care utilization in MF TD patients.  Potential short term and long term benefits of ICT in MF need to be validated in prospective clinical trials.