ASH Issues 2026 Guidelines for Managing Myelofibrosis in Adults

The American Society of Hematology’s 2026 guidelines address management of adults with myelofibrosis, a myeloid malignancy associated with symptoms, splenomegaly, cytopenias, thrombosis or hemorrhage, and possible blast-phase transformation. A multidisciplinary panel, including myelofibrosis and transplantation specialists and two patient representatives, developed recommendations with support from the Mayo Clinic Evidence-based Practice Center. Systematic evidence reviews covered literature through January 31, 2025; recommendations used GRADE evidence assessment and decision frameworks and underwent public comment.

The panel agreed on 10 recommendations covering prognostic testing, indications for interferon and JAK inhibitors, myelofibrosis-associated anemia, transplantation timing, antiplatelet therapy and iron chelation. Highlighted suggestions include extended molecular genetic testing and JAK inhibition for symptomatic patients with lower-risk disease. The guidelines also address disease-associated and JAK-inhibitor-induced anemia, transplantation referral timing and optimization before transplantation.

The recommendations frame treatment around symptom burden, prognosis and the benefits and risks of available therapies. However, the available abstract does not specify individual drug choices, detailed eligibility criteria, recommendation strength or evidence certainty. Clinicians should consult the full guideline before applying specific treatment or referral recommendations. The panel identified research priorities for all recommendations.