The German ONKOPEDIA Guideline for Myelofibrosis in 2025—Recommendations of an MPN Expert Panel of the German Society for Hematology and Oncology (DGHO)

DGHO (Onkopedia) · 2026 · Germany

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Authors: Martin Griesshammer, Haifa Kathrin Al‐Ali, Gabriela M. Baerlocher et al.
Title: The German ONKOPEDIA Guideline for Myelofibrosis in 2025—Recommendations of an MPN Expert Panel of the German Society for Hematology and Oncology (DGHO)
Journal: International Journal of Cancer, 2026
DOI: 10.1002/ijc.70595
Licence: CC BY 4.0
Changes: Verbatim excerpts; formatting adapted

Full text retrieved 2026-10-27 from Europe PMC · PMC13432566

Licence statement of the original publication

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Recommendations

Verbatim, with grade of recommendation or strength of consensus where given.

Recommendations for the Pre‐Fibrotic Phase of Myelofibrosis

The pre‐fibrotic phase of primary myelofibrosis (pre‐PMF) is now firmly recognized as a distinct clinical and pathological entity within the MPN spectrum, clearly separated from essential thrombocythemia (ET) and overt PMF by the WHO (2016, 2022) and ICC (2022) classifications [7, 8]. The differences between WHO 2022 and ICC 2022 for pre‐PMF are mainly related to wording, emphasis, and the presentation of clonality criteria, whereas the overall diagnostic framework remains highly concordant. Accurate diagnosis is essential but remains challenging, as clinical overlap with ET and early PMF is frequent, and misclassification may lead to inappropriate treatment strategies. Diagnosis requires integration of bone marrow histopathology—characterized by hypercellularity, atypical megakaryopoiesis, and minimal reticulin fibrosis (grade 0–1)—with molecular findings (JAK2, CALR, or MPL mutations, or other clonal markers) and minor criteria including anemia, leukocytosis, splenomegaly, or elevated LDH. Communication between clinicians and expert hematopathologists is strongly recommended to ensure diagnostic precision.

Abstract

The recently published ONKOPEDIA guideline on myelofibrosis, issued under the auspices of the German Society of Hematology and Oncology (DGHO), provides an updated, evidence‐based framework for the diagnosis and management of this rare, chronic myeloproliferative neoplasm. Developed by a panel of experts (including Germany, Austria and Switzerland) nominated by the DGHO, the guideline reflects a structured and consensus‐oriented process in which internationally recognized specialists in hematology critically reviewed the available evidence, revised the written draft, and engaged in multiple rounds of discussion to ensure consistency, clinical relevance, and scientific rigor. This update builds upon the foundation of the previously available ONKOPEDIA guideline (accessible at www.onkopedia.com), but extends and refines the recommendations in light of several important recent developments.

Contents of the original publication

The section headings of the original.

Guideline Generation by an International Expert Panel
The 2025 Update of the ONKOPEDIA Guidelines on MF
Stronger Emphasis on Symptom Burden
Recommendations for the Pre‐Fibrotic Phase of Myelofibrosis
Use of Molecular Risk Scores
Update on JAK‐Inhibitor Use and Stratification
New Therapeutic Options
Identification of Ruxolitinib Failure by Clinical Practice Tools
The Updated MF‐ONKOPEDIA‐Guidelines in Context of International Treatment Recommendations: Comparison With the NCCN‐Guidelines for MF
Risk Stratification and Diagnostic Frameworks
Weighting of Symptom Burden in Initial Assessment and Follow‐Up
JAK‐Inhibitor Selection and Sequencing: Platelets, Anemia, and Geography
Management of MF‐Associated Anemia and “New” Options
Recognition of Ruxolitinib Failure and Timing of Transition
Transplant Referral and Timing Strategies
Novel Therapeutic Approaches and Pipeline Integration
Summary
Key Messages

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