Theme 1 consensus recommendations
| Defining the thresholds for anemia, and when to initiate or modify treatment . | Strength of recommendation,∗ median score (mean score) . | Level of consensus† . |
|---|---|---|
| Q1. When should blood transfusions be initiated? What are the advantages, disadvantages, and impact on allo-HSCT outcomes? Consensus statement Blood transfusions should be considered for patients:
| 9 (8.81) | n/N = 26/27 (96.30%) |
Q2. When should nontransfusion–based anemia treatment be considered for:
Consensus statement For patients with MF- or treatment-related anemia symptoms (eg, fatigue and shortness of breath) not yet requiring transfusion, nontransfusion–based treatment should be considered at an Hb threshold of <10 g/dL. Hb levels may decrease to <10 g/dL during the first few weeks of ruxolitinib treatment. Usually, this decrease in Hb level is well tolerated, recovers after the first 3 mo of therapy, and may not require pharmacological treatment. Anemia treatment should be initiated if clinically required, or if anemia persists after 12 wk of ruxolitinib; if possible, JAKi dose should be maintained to achieve the spleen size reduction and symptom benefit. In clinical practice, treatment success may be defined as meeting specified treatment goals. For example, improvement in Hb levels and/or anemia symptoms. | 9 (8.50) | n/N = 25/26 (96.15%) |
| Q3. How does drug availability affect anemia treatment in the LATAM region? Consensus statement Anemia treatment in the LATAM region is impacted by drug approval status and reimbursement, and restrictions may be in place for certain agents in certain countries. The availability of agents can also be affected by stockouts, leading to potential disruptions in patient care. Where JAKi therapies with proven anemia benefits (such as momelotinib and pacritinib) are unavailable, patients receiving other JAKi therapies may benefit from add-on treatments (eg, danazol, ESAs, IMiDs, or low-dose corticosteroids). | 9 (8.58) | n/N = 26/26 (100%) |
| Defining the thresholds for anemia, and when to initiate or modify treatment . | Strength of recommendation,∗ median score (mean score) . | Level of consensus† . |
|---|---|---|
| Q1. When should blood transfusions be initiated? What are the advantages, disadvantages, and impact on allo-HSCT outcomes? Consensus statement Blood transfusions should be considered for patients:
| 9 (8.81) | n/N = 26/27 (96.30%) |
Q2. When should nontransfusion–based anemia treatment be considered for:
Consensus statement For patients with MF- or treatment-related anemia symptoms (eg, fatigue and shortness of breath) not yet requiring transfusion, nontransfusion–based treatment should be considered at an Hb threshold of <10 g/dL. Hb levels may decrease to <10 g/dL during the first few weeks of ruxolitinib treatment. Usually, this decrease in Hb level is well tolerated, recovers after the first 3 mo of therapy, and may not require pharmacological treatment. Anemia treatment should be initiated if clinically required, or if anemia persists after 12 wk of ruxolitinib; if possible, JAKi dose should be maintained to achieve the spleen size reduction and symptom benefit. In clinical practice, treatment success may be defined as meeting specified treatment goals. For example, improvement in Hb levels and/or anemia symptoms. | 9 (8.50) | n/N = 25/26 (96.15%) |
| Q3. How does drug availability affect anemia treatment in the LATAM region? Consensus statement Anemia treatment in the LATAM region is impacted by drug approval status and reimbursement, and restrictions may be in place for certain agents in certain countries. The availability of agents can also be affected by stockouts, leading to potential disruptions in patient care. Where JAKi therapies with proven anemia benefits (such as momelotinib and pacritinib) are unavailable, patients receiving other JAKi therapies may benefit from add-on treatments (eg, danazol, ESAs, IMiDs, or low-dose corticosteroids). | 9 (8.58) | n/N = 26/26 (100%) |
ESA, erythropoiesis-stimulating agent; IMiD, immunomodulatory imide drug; Q, question.
Median score on a 1 to 9 scale (mean score in parentheses).
Percentage of votes with 7 to 9 on a 9-point scale. Participants were provided with the voting option “Not Applicable” for recommendations outside their area expertise.