Blood advances · 2026
American Society of Hematology 2026 Guidelines for the Management of Myelofibrosis in Adults.
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Stein Brady L, Abdallah Maya M, Abel Gregory A, Abu-Zeinah Ghaith, Bhave Rupali Roy, Ferrer-Marin Francisca, Gandhi Arpita, Gupta Vikas, Hernandez-Boluda Juan Carlos, Hunter Anthony Michael, McLornan Donal P, Odenike Olatoyosi, Pettit Kristen M, Shomali William, Sirhan Shireen, Srisuwananukorn Andrew, Szuber Natasha, Tamari Roni, Tremblay Douglas, Vannucchi Alessandro M, Clark Kelley, Jenkins Lisa, Hasan Bashar, Murad Mohammad Hassan
Аннотация
BACKGROUND: Myelofibrosis (MF) is a myeloid bone marrow malignancy with a progressive clinical course marked by disease-related symptoms, splenomegaly, cytopenias, thrombosis/hemorrhage, and a risk for blast phase transformation. Treatment recommendations are based on the burden of symptoms, prognosis of the disease, and benefits/risks of each treatment modality.
METHODS: ASH formed a multidisciplinary guideline panel that included specialists in myelofibrosis and hematopoietic cell transplantation, as well 2 patient representatives and was balanced to minimize potential bias from conflicts of interest. The Mayo Clinic Evidence-based Practice Center supported the guideline development process, including updating or performing systematic evidence reviews (up to January 31, 2025). The panel prioritized clinical questions and outcomes according to their importance for patients and clinicians. The panel used the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach, including GRADE Evidence-to-Decision frameworks, to assess evidence and make recommendations, which were subject to public comment.
RESULTS: The panel agreed on 10 recommendations regarding prognostic testing, indications for interferon and JAK inhibitor therapy, management of MF-associated anemia, timing of transplantation, anti-platelet therapy, and iron chelation.
CONCLUSIONS: Key recommendations of these guidelines include suggestions for extended molecular genetic testing; use of JAK-inhibition in symptomatic, lower risk MF patients; therapeutic strategies for patients with MF-anemia and JAK-inhibitor induced anemia; and considerations regarding hematopoietic cell transplantation including timing of referral and optimization prior to the procedure. Key future research agendas were identified for all recommendations.
METHODS: ASH formed a multidisciplinary guideline panel that included specialists in myelofibrosis and hematopoietic cell transplantation, as well 2 patient representatives and was balanced to minimize potential bias from conflicts of interest. The Mayo Clinic Evidence-based Practice Center supported the guideline development process, including updating or performing systematic evidence reviews (up to January 31, 2025). The panel prioritized clinical questions and outcomes according to their importance for patients and clinicians. The panel used the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach, including GRADE Evidence-to-Decision frameworks, to assess evidence and make recommendations, which were subject to public comment.
RESULTS: The panel agreed on 10 recommendations regarding prognostic testing, indications for interferon and JAK inhibitor therapy, management of MF-associated anemia, timing of transplantation, anti-platelet therapy, and iron chelation.
CONCLUSIONS: Key recommendations of these guidelines include suggestions for extended molecular genetic testing; use of JAK-inhibition in symptomatic, lower risk MF patients; therapeutic strategies for patients with MF-anemia and JAK-inhibitor induced anemia; and considerations regarding hematopoietic cell transplantation including timing of referral and optimization prior to the procedure. Key future research agendas were identified for all recommendations.