Risk Stratification and the Evolving Role of Biomarkers in Myelofibrosis

Risk assessment in myelofibrosis integrates clinical features, blood counts, symptoms, and molecular findings to classify patients as low-, intermediate-, or high-risk. Low-risk individuals often have preserved blood counts, fewer symptoms, and lack high-risk mutations, while intermediate-risk patients may exhibit anemia, splenomegaly, or early molecular complexity. High-risk disease is typically marked by significant cytopenias, transfusion dependence, severe symptoms, or multiple adverse mutations. Biomarker testing is central to this assessment. Routine evaluation for JAK2, CALR, and MPL driver mutations helps define disease biology and provides prognostic insights. Increasingly, next-generation sequencing is used to identify additional mutations linked to higher-risk disease, aiding in treatment selection, transplant discussions, and closer monitoring. Together, molecular testing and clinical assessment guide more personalized management in myelofibrosis.