NCCN Guidelines for MPN (V2.2026): Updates for myelofibrosis

Updates from the National Comprehensive Cancer Network (NCCN) Guidelines for Myeloproliferative Neoplasms (MPN), Version 2.2026, were published in the Journal of the National Comprehensive Cancer Network by Gerds et al. These guideline insights focus on updates for the treatment of myelofibrosis (MF). 

Key data: Key updates include revised risk stratification models for post-polycythemia vera (PV) and post-essential thrombocythemia (ET) MF, with the Mutation and Karyotype-Enhanced International Prognostic Scoring System Version 2.0 for patients aged ≤70 years (MIPSS70+ v2.0) designated as the preferred prognostic model. Momelotinib and pacritinib were added as Janus kinase inhibitor (JAKi) treatment options across risk categories. Updated anemia management pathways now position momelotinib as a Category 1 preferred option for patients with ongoing symptomatic splenomegaly and/or constitutional symptoms, while clinical trial enrollment is a preferred option across the anemia management scenarios. Post-allogeneic hematopoietic stem cell transplantation (allo-HSCT) measurable residual disease (MRD) monitoring is also now recommended. 

Key learning: Version 2.2026 of the NCCN Guidelines for MPN introduces clinically meaningful updates for MF, including expanded JAKi treatment options, refined anemia management algorithms that prioritize momelotinib in appropriate patients, and updated guidance on MRD monitoring after allo-HSCT.