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Pre-PMF is characterized by unique morphological, clinical, and molecular features, distinguishing it from essential thrombocythemia (ET) and overt myelofibrosis (overt-PMF). The diagnostic process for pre-PMF relies on bone marrow histology, identification of molecular mutations and exclusion of other myeloid neoplasms. Misclassification remains a significant challenge due to overlapping phenotypes and the heterogeneity of clinical presentations, which range from asymptomatic cases to severe cytopenias and a high thrombotic risk. Management strategies for pre-PMF focus on mitigating symptom burden, reducing thromboembolic events, and preventing disease progression. Low-risk patients often benefit from observational approaches or low-dose aspirin, while cytoreductive therapies, such as hydroxyurea or interferon-alpha, are utilized in symptomatic or high-risk cases. JAK inhibitors like ruxolitinib have shown promise in addressing splenomegaly and systemic symptoms, although their role in pre-PMF requires further investigation. Advances in artificial intelligence are enhancing diagnostic precision by refining bone marrow histopathological analysis, paving the way for more accurate disease classification and tailored therapeutic strategies. This position paper integrates insights from a German expert panel discussion, underscoring the need for interdisciplinary collaboration, adherence to updated WHO\/ICC diagnostic criteria, and personalized treatment approaches. By addressing diagnostic challenges and therapeutic nuances, it seeks to improve outcomes and quality of life for patients navigating the complexities of pre-PMF.<\/jats:p>","DOI":"10.1007\/s00277-025-06191-7","type":"journal-article","created":{"date-parts":[[2025,1,31]],"date-time":"2025-01-31T04:50:57Z","timestamp":1738299057000},"page":"295-306","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":11,"title":["How I diagnose and treat patients in the pre-fibrotic phase of primary myelofibrosis (pre-PMF) - practical approaches of a German expert panel discussion in 2024"],"prefix":"10.1007","volume":"104","author":[{"given":"Martin","family":"Griesshammer","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Haifa Kathrin","family":"Al-Ali","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jan-Niklas","family":"Eckardt","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael","family":"Fiegl","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joachim","family":"G\u00f6thert","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kathleen","family":"Jentsch-Ullrich","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Steffen","family":"Koschmieder","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hans Michael","family":"Kvasnicka","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andreas","family":"Reiter","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Burkhard","family":"Schmidt","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2438-1955","authenticated-orcid":false,"given":"Florian H.","family":"Heidel","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2025,1,31]]},"reference":[{"key":"6191_CR1","doi-asserted-by":"publisher","unstructured":"Arber DA, Orazi A, Hasserjian RP, Borowitz MJ, Calvo KR, Kvasnicka HM, Wang SA, Bagg A, Barbui T, Branford S, Bueso-Ramos CE, Cortes J, Dal Cin P, DiNardo CD, Dombret H, Duncavage EJ, Ebert BL, Estey E, Facchetti F, Foucar K, Gangat N, Gianelli U, Godley LA, Goekbuget N, Gotlib JR, Hellstrom-Lindberg E, Hobbs G, Hoffman R, Jabbour EJ, Kiladjian JJ, Larson RA, Le Beau MM, Loh ML, Lowenberg B, Macintyre EA, Malcovati L, Mullighan CG, Niemeyer CM, Odenike O, Ogawa S, Orfao A, Papaemmanuil E, Passamonti F, Porkka K, Pui CH, Radich JP, Reiter A, Rozman M, Rudelius M, Savona MR, Schiffer C, Schmitt-Graeff A, Shimamura A, Sierra J, Stock W, Stone RM, Tallman MS, Thiele J, Tien HF, Tzankov A, Vannucchi AM, Vyas P, Wei AH, Weinberg OK, Wierzbowska A, Cazzola M, Dohner H, Tefferi A (2022) International Consensus Classification of Myeloid Neoplasms and Acute Leukemia: Integrating Morphological, Clinical, and Genomic Data. 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JNE received research funding from Novartis; advisory boards or consulting fees from AstraZeneca, Johnson&Johnson, and Novartis; received honoraria from Amgen, AstraZeneca, Novartis, and Pfizer; received travel support from AstraZeneca, Johnson&Johnson, and Merck; is a co-owner of Cancilico; had a patent issued for artificial intelligence-based image classification software. SK received research funding from Geron, Janssen, AOP Pharma, and Novartis; received advisory board or consulting fees from Pfizer, Incyte, Ariad, Novartis, AOP Pharma, Bristol Myers Squibb, Celgene, Geron, Janssen, CTI BioPharma, Roche, Bayer, GSK, Sierra Oncology, PharmaEssentia, and MSD; received payment or honoraria from Novartis, BMS\/Celgene, Pfizer; received travel\/accommodation support from Alexion, Novartis, Bristol Myers Squibb, Incyte, AOP Pharma, CTI BioPharma, Pfizer, Celgene, Janssen, Geron, Roche, AbbVie, GSK, Sierra Oncology, Kartos, and MSD; had a patent issued for a BET inhibitor at RWTH Aachen University. BS received advisory board or consulting fees from AbbVie, AOP Pharma, AstraZeneca, BeiGene, Bristol Myers Squibb, Hexal, Incyte, Janssen-Cilag, Novartis, Oncopeptides, Pfizer, Sanofi and SoBi. FHH served as an advisor for Novartis, CTI, Celgene\/BMS, Janssen, Abbvie, GSK, Merck and AOP and received research funding from Novartis, Celgene\/BMS and CTI.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}]}}