Symposium | Future perspectives for cytopenic MF: Panel discussion and Q&A

At the European School of Haematology (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, and Steering Committee members Steffen Koschmieder, Uniklinik RWTH Aachen, DE, and Claire Harrison, Guy’s and St Thomas’ NHS Foundation Trust, London, UK, discuss future perspectives for cytopenic myelofibrosis (MF) during a panel discussion and Q&A session. 

In this session, Kiladjian, Koschmieder, and Harrison discuss practical approaches to the management of cytopenias in MF, including treatment selection, management of treatment-emergent anemia, supportive care strategies, and future directions for individualized and combination therapies. 

Key points 

• Management of MF-associated anemia should consider the timing of onset, severity, ongoing spleen/symptom response, and available treatment options.^1,2 
• Early-onset anemia (typically within the first 16 weeks) may be transient; unnecessary ruxolitinib dose reductions should be avoided where possible because efficacy is dose dependent.¹ 
• Red blood cell transfusions may be used as supportive therapy for early treatment-related anemia and may become unnecessary as hemoglobin recovers.^1–3 
• In patients with sustained spleen and symptom benefit but persistent anemia, addition of an anemia-directed therapy may be considered before switching Janus kinase (JAK) inhibitor therapy.^1–3 
• Switching to an alternative JAK inhibitor may be appropriate for patients with clinically significant or severe anemia, particularly when anemia limits continued treatment.^2,3 
• Direct switching between ruxolitinib and momelotinib has been shown to be feasible in clinical pracice.⁴ 
• First-line treatment selection should be individualized according to disease phenotype, including anemia severity, thrombocytopenia, splenomegaly, symptom burden, comorbidities, and patient preferences.^1–3 
• Clinically relevant anemia, rather than hemoglobin threshold alone, should guide treatment selection, although hemoglobin <10 g/dL was discussed as a practical consideration.^1–3 
• In the context of progression from essential thrombocytopenia (ET) to MF, new or worsening cytopenias after a prolonged period of stable treatment should prompt evaluation for disease progression, including assessment of symptoms, lactate dehydrogenase, peripheral blood smear, circulating blasts, and repeat bone marrow examination when appropriate.³ 
• Limited clinical experience exists with erythropoiesis-stimulating agents added to JAK inhibitor therapy; thrombotic risk should be considered and monitored, particularly in patients with additional risk factors.³ 
• Evidence supporting sodium-glucose co-transporter-2 (SGLT2) inhibitors for improving anemia in MF remains preliminary.⁵ 
• When treating patients with MF and anemia, potential adverse events, for example neuropathy, should be carefully considered. Patient education regarding adverse events, as well as strategies for their prevention and management, should be optimized.⁶ 
• Future management of MF is expected to incorporate both single-agent treatment and combination strategies in increasingly personalized treatment approaches based on disease characteristics and patient factors.⁶ 

This educational resource is independently supported by GSK. All content is developed by the faculty in collaboration with SES. Funders are allowed no influence.