ASH Issues New Guidelines for Individualized Myelofibrosis Management

The American Society of Hematology (ASH) has issued new clinical practice guidelines for myelofibrosis that emphasize expanded molecular testing, earlier transplant consultation for higher-risk patients, and individualized use of Janus kinase (JAK) inhibitors.^1,2

The guidelines, published in Blood Advances, comprise 10 recommendations intended to address gaps in myelofibrosis management, where treatment approaches can vary among clinicians because of the disease’s rarity and progressive nature. The guidelines were developed through a multidisciplinary process that included a panel of myelofibrosis and transplant specialists, methodology experts, and a patient and caregiver with lived experience. The resulting recommendations span diagnosis, treatment selection, anemia management, and transplant planning.

“These recommendations address questions that routinely come up for clinicians and patients managing myelofibrosis, and our hope is that they will enable hematologists to more confidently deliver better care to their patients,” Brady Stein, MD, professor of medicine at Northwestern University’s Feinberg School of Medicine and guideline panel chair, stated in a news release. “That said, important gaps in evidence remain, and we hope the questions we asked can help set a future research agenda to further improve care for patients with this disease.”

Expanded Testing and Transplant Planning

The recommendations emphasize molecular assessment as part of the initial myelofibrosis evaluation. Extended testing can help identify high-risk mutations, providing additional information to guide clinical management. Incorporating these findings into treatment planning may facilitate individualization of treatment decisions according to disease characteristics and patient risk.

Transplant planning is another central component of the guidance. Allogeneic stem cell transplantation remains a potentially curative treatment for myelofibrosis, although not every patient is eligible for the procedure. ASH recommends early transplant consultation for higher-risk patients who are receiving and responding to JAK inhibitor therapy.

Tailoring JAK Inhibitor Use to Disease Risk and Symptoms

JAK inhibitors can help reduce splenomegaly and alleviate other myelofibrosis-related symptoms. However, the new recommendations distinguish between patients according to disease risk and symptom burden.

For lower-risk patients experiencing disease-related symptoms, ASH recommends considering JAK inhibitor therapy. Conversely, the guidance recommends avoiding JAK inhibitors in higher-risk patients who do not have disease-related symptoms.

These recommendations underscore the need to evaluate both risk and clinical presentation when making treatment decisions, rather than relying on disease risk alone. Symptom burden, spleen enlargement, molecular findings, and transplant eligibility are among the factors relevant to individualized care.

The recommendations also address anemia associated with myelofibrosis or JAK inhibitor treatment. Anemia can complicate disease management, and the guidance identifies its management as an area requiring attention when selecting and monitoring treatment.

Aspirin Use and Thrombotic Risk

The guidelines also address low-dose aspirin use in patients with the JAK2 V617F mutation. Myelofibrosis is associated with serious disease-related complications, including blood clots, and the recommendation provides guidance on aspirin use in this genetically defined patient population.

Evidence Gaps and Future Research

Despite the recommendations, the guidelines identify several areas in which additional evidence is needed. These include improving the ability to predict which patients will benefit from specific treatments, establishing better approaches to myelofibrosis-related anemia, and clarifying the optimal timing of transplantation.

The guidance ultimately reinforces an individualized approach that integrates molecular findings, disease risk, symptoms, treatment response, and transplant eligibility. Further research will be needed to refine treatment selection, improve anemia management, and establish when transplant consultation and intervention are most appropriate.

REFERENCES

1. Stein BL, Abdallah MM, Abel GA, et al. American Society of Hematology 2026 Guidelines for the Management of Myelofibrosis in Adults. Blood Adv. Published online October 14, 2026. doi:10.1182/bloodadvances.2026021650

2. ASH Issues New Recommendations to Improve Myelofibrosis Care. News release. American Society of Hematology. October 14, 2026. Accessed October 14, 2026. https://tinyurl.com/ykzzvwdp‌