ASH releases 2026 guidelines for myelofibrosis management

The American Society of Hematology (ASH) has released its 2026 clinical guidelines for adult myelofibrosis (MF), developed by a panel of hematologists, transplant physicians, and patient/caregiver representatives. Published in Blood Advances, the 10 recommendations were built using a systematic literature review and the GRADE framework to assess evidence strength.

The guidelines tackle some of the most common clinical questions around MF management — from diagnosis to transplant timing. Notably, the panel advises against the routine use of pegylated interferon and instead favors JAK inhibitors for symptomatic patients across risk categories. For anemia-predominant cases, treatment choice should be guided by severity, and JAK inhibitor-induced anemia should prompt dose optimization or a therapy switch.

Key Takeaways:

• All MF patients should undergo extended molecular genetic testing at diagnosis, repeated as needed at disease progression or pre-transplant
• JAK inhibitors are recommended for lower- and higher-risk symptomatic MF
• Early transplant referral is advised for higher-risk patients while still responding to JAK inhibitor therapy — referral doesn't mean transplant is imminent
• High-risk molecular and cytogenetic features should prioritize patients for allogeneic HCT

Why it matters: These guidelines give clinicians a clearer, evidence-backed roadmap for a complex and heterogeneous disease, potentially improving outcomes by standardizing when to test, treat, and refer.