MF is a rare chronic hematologic malignancy. It is imperative that patients be referred for a consultation to a center with expertise in the management of MF. The authors believe in a shared care model where the community hematologist/oncologist and the MPN specialist jointly manage the patient with MF.

Risk stratification is vital for choosing an optimal treatment strategy and should be done at the time of diagnosis and reviewed periodically during follow-up to identify a change in risk profile.

The goals of therapy for each patient need to be defined upfront, taking into consideration factors, such as age, symptom burden, predicted risk of mortality and leukemic transformation, availability of donors, and personal risk tolerance.

Therapy should be individualized and include a spectrum of choices ranging from watchful waiting to drug therapy or HCT.

Ideally, transplant-eligible patients should make the decision about the choice of initial therapy after receiving a transplantation consultation, and full understanding of risks/benefits associated with HCT versus nontransplantation therapy.

Patients experiencing symptom relief and improved performance status on JAK1/2 inhibitor therapy could also consider the option of subsequent HCT.

Transplant-eligible patients pursuing a curative goal in the setting of higher-risk MF should proceed to HCT sooner than later, as worsening disease risk score predicts lower posttransplantation survival.

Suggested algorithms (Figure 2A-B) and aids to decision making (Figure 3) may further assist in refining treatment decisions in an individual patient.