Symposium | Cytopenias in MF: Clinical burden and the need for prioritized management

At the ESH 11th Translational Research Conference: Myeloproliferative Neoplasms, Apr 24–26, 2026, Estoril, PT, the MPN Hub held a symposium, titled Patient-centered approaches in myelofibrosis: Tailoring treatment for anemia and thrombocytopenia. During the symposium, MPN Hub Steering Committee Chair Jean-Jacques Kiladjian, Université Paris Cité - Hôpital Saint-Louis, Paris, FR, delivered a presentation on cytopenias in myelofibrosis (MF), with a focus on clinical burden and the need for prioritized management. 

In this presentation, Kiladjian discusses the drivers and incidence of cytopenias in MF, transfusion burden associated with anemia, the impact of cytopenias on symptom burden and quality of life (QoL), treatment adjustments necessitated by cytopenias, and the impact of cytopenias on outcomes, highlighting that cytopenia management is central to patient-centered care in MF. 

Key points 

• The drivers of anemia and thrombocytopenia in MF are multifactorial (Figure 1), and the pathogenesis of anemia in MF is only partially understood.^1,2 

• Cytopenias are a common clinical manifestation of MF, with anemia (defined as hemoglobin <10 g/dL) present in almost 40% of all patients with MF at diagnosis and thrombocytopenia (defined as platelet count <100 × 10⁹/L) in 16–26% of patients at diagnosis.^1,2 
• Anemia in MF often leads to transfusion dependence, with around a quarter of patients red blood cell (RBC)-transfusion dependent at diagnosis and most patients developing transfusion dependence over their disease course.¹ 
• RBC transfusion-dependence is associated with poorer QoL and reduced survival compared with transfusion independence.¹ 
• Cytopenias in MF have significant impacts on symptom burden and QoL, and these impacts increase with worsening anemia and thrombocytopenia.^3–5 
• Cytopenias in MF often result in treatment modifications, with anemia and thrombocytopenia among the most common reasons for dose modification.^6,7 
• Dose reductions and dose interruptions due to cytopenias are reported in 67.4% and 27.2% of patients with MF, respectively.^6,7 
• Cytopenias are associated with reduced survival in MF, with the presence of severe anemia or transfusion dependence associated with a 1.5-fold increase in risk of death vs moderate anemia, and the presence of thrombocytopenia associated with a 1.4-fold increase in risk of death vs platelet counts >100 × 10⁹/L (Figure 2).^8,9 Increasing severity of cytopenias is associated with progressively poorer overall survival.^8,9 

• Cytopenia management is central to patient-centered care in MF, and treatment strategies should address cytopenias, in order to reduce transfusion dependence, improve QoL, reduce dose reductions/interruptions, and improve prognosis.^1,8,9 

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