Clinical Practice Recommendations for Myelofibrosis Management in the Asia-Pacific Region: The APAC-MF Alliance

Abstract

Purpose: Myelofibrosis (MF) is a complex and clinically heterogeneous myeloproliferative neoplasm, presenting significant challenges for patient care and clinical decision making. Although global guidelines exist for MF management and continue to evolve with the advent of novel therapies, they do not consider regional variations in drug accessibility nor the availability of diagnostic tools and resources. The notable gap in regional guidance for managing patients with MF in the Asia-Pacific (APAC) region has led to regional disparities in patient care practices. To bridge this gap, a steering committee (SC) of 14 expert hematologists from the APAC region collaborated to develop evidence- and consensus-based consensus statements (CSs) for MF management in the APAC region.

Materials and methods: On the basis of evidence from a systematic literature review and their own clinical experience, the SC drafted 13 clinical practice recommendations across four consensus themes: (1) defining the thresholds for anemia and when to initiate or modify treatment; (2) defining when to initiate or modify treatment for thrombocytopenia; (3) defining Janus kinase inhibitor failure and what would warrant switching treatment; and (4) defining the most appropriate risk stratification model for MF in the APAC region. The SC and an extended faculty (EF) of 47 hematologists and two patients voted on the CSs in a modified Delphi process using a 9-point scale (1 = strongly disagree, 9 = strongly agree), with consensus achieved when 75% agreed within the range of 7-9.

Results: Following amendments to align with EF feedback, consensus was achieved for all 13 CSs.

Conclusion: These CSs offer pragmatic guidance tailored to the MF landscape in the APAC region, which aims to enhance the quality of patient care and outcomes. The CSs in this study are formally endorsed by the Asian Myeloid Working Group.