Primary myelofibrosis: lines of therapy

Cancer page →

5 standard-of-care settings across 2 lines and 2 biomarker subgroups. Rows come from the cancer page's standard of care; the grid places each on its line and subgroup.

Line	All comers	Fit
Advanced, first line	·	1
Other settings	4	·

Advanced, first line

Subgroup	Setting	Approach	Products and trials	Guideline	Evidence
Fit	Higher-risk, fit for transplant	Allogeneic stem cell transplant, usually under 70 and at MIPSS70 high or DIPSS intermediate-2 or higher, after JAK inhibitor to reduce spleen size.	Allogeneic stem cell transplantationRuxolitinibConditioning regimen (myeloablative, reduced-intensity)	NCCN Guidelines: Myeloproliferative Neoplasms	92

Other settings

Subgroup	Setting	Approach	Products and trials	Guideline	Evidence
All comers	Lower-risk, asymptomatic	Observation; aspirin for thrombosis risk where platelets are high; hydroxyurea or interferon for proliferative features.	AspirinHydroxyurea (hydroxycarbamide)Ropeginterferon alfa-2bPeginterferon alfa-2b	NCCN Guidelines: Myeloproliferative Neoplasms	76
All comers	Symptomatic splenomegaly or constitutional symptoms	Ruxolitinib (COMFORT-I and II) first; fedratinib after ruxolitinib failure or intolerance; pacritinib if platelets are below 50 x 10^9/L; momelotinib if anaemic.	RuxolitinibFedratinibPacritinibMomelotinib	NCCN Guidelines: Myeloproliferative Neoplasms	87
All comers	Anaemia of myelofibrosis	Momelotinib (MOMENTUM), erythropoiesis-stimulating agents where erythropoietin is low, danazol, transfusion with iron chelation; luspatercept in trials (INDEPENDENCE).	MomelotinibEpoetin alfaTransfusion support and anaemia managementLuspaterceptAn Efficacy and Safety Study of Luspatercept (ACE-536) Versus Placebo in Subjects With Myeloproliferative Neoplasm-Associated Myelofibrosis on ConcomiStudy of DISC-0974 (RALLY-MF) in Participants With Myelofibrosis or Myelodysplastic Syndrome and Anemia	NCCN Guidelines: Myeloproliferative Neoplasms	84
All comers	Ruxolitinib failure and trials	Switch JAK inhibitor; combination trials of ruxolitinib with navitoclax, pelabresib, selinexor or imetelstat; imetelstat versus best available therapy in IMpactMF.	NavitoclaxPelabresibSelinexorImetelstatStudy of Oral Navitoclax Tablet in Combination With Oral Ruxolitinib Tablet Versus Best Available Therapy to Assess Change in Spleen Volume in Adult Participants With Relapsed/Refractory MyelofibrosisStudy of Selinexor in Combination With Ruxolitinib in MyelofibrosisA Study Comparing Imetelstat Versus Best Available Therapy for the Treatment of Intermediate-2 or High-risk Myelofibrosis (MF) Who Have Not Responded to Janus Kinase (JAK)-Inhibitor TreatmentExtended Access of Momelotinib in Adults With Myelofibrosis		69

Lines and subgroups are parsed from the setting text of each standard-of-care row and can misclassify an unusual phrasing; the row’s own setting is always shown. Guideline chips reflect the NCCN category and ESMO-MCBS grade recorded on the cancer page, checked on its stated date. Not medical advice.