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Risk factors for disease progression include advanced age and the presence of certain acquired myeloid-relevant mutations. A better understanding of what defines disease progression in PV is essential when evaluating treatment options that enable disease modification and improved patient outcomes. A modified-Delphi method was used to convene a virtual steering group (SG) of seven US-based clinical physicians specializing in the management and treatment of PV. The group generated 41 consensus statements across six main domains. A survey was developed from these statements and shared with a broader panel of specialists, using a four-point\n                    <jats:italic>Likert<\/jats:italic>\n                    scale. The results were analyzed to determine the level of agreement for each statement. The consensus threshold was set at 75% agreement. A total of 61 responses were received from hematologist-oncologists (\n                    <jats:italic>n<\/jats:italic>\n                    \u2009=\u200956), oncologists (\n                    <jats:italic>n<\/jats:italic>\n                    \u2009=\u20093), and hematologists (\n                    <jats:italic>n<\/jats:italic>\n                    \u2009=\u20092). On analysis, 39\/41 (95%) statements achieved consensus agreement, and 2\/41 (5%) failed to achieve consensus. Consensus statements related to response assessment adjudication, treatment selection, and disease progression scored the highest, with 92% consensus among the wider panel. Based on the consensus, the SG agreed on a set of recommendations for defining disease progression and disease modification in PV. These recommendations aim to improve understanding of the disease course to support the development of more effective therapeutic strategies.\n                  <\/jats:p>","DOI":"10.1007\/s00277-025-06641-2","type":"journal-article","created":{"date-parts":[[2025,10,15]],"date-time":"2025-10-15T06:49:15Z","timestamp":1760510955000},"page":"5063-5075","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Results from a US modified Delphi consensus to define disease progression and disease modification in polycythemia Vera"],"prefix":"10.1007","volume":"104","author":[{"given":"Prithviraj","family":"Bose","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Emily","family":"Nagler","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Muhammad Sarfraz","family":"Nawaz","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Raajit K.","family":"Rampal","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tsewang","family":"Tashi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Swapna","family":"Thota","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8400-0483","authenticated-orcid":false,"given":"John O.","family":"Mascarenhas","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2025,10,15]]},"reference":[{"key":"6641_CR1","doi-asserted-by":"publisher","first-page":"1465","DOI":"10.1002\/ajh.27002","volume":"98","author":"A Tefferi","year":"2023","unstructured":"Tefferi A, Barbui T (2023) Polycythemia vera: 2024 update on diagnosis, risk-stratification, and management. 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All authors received funding from PharmaEssentia while undertaking this study. PharmaEssentia commissioned Triducive Partners Limited to facilitate the project and analyze the responses to the consensus statements in line with the Delphi methodology. After engaging Triducive Partners Limited, PharmaEssentia made no contribution to the design and development of the study outside of payment of honoraria. PharmaEssentia took no part in the writing, revision, or editing of the manuscript.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}},{"value":"PB reports research support from Incyte, BMS, CTI (now Sobi), Kartos, Telios, Morphosys, Ajax, Geron, Janssen, Sumitomo, Karyopharm, Ionis, Disc, Blueprint, and Cogent, and honoraria\/consulting fees from Incyte, BMS, CTI (now Sobi), GSK, Morphosys (now Novartis), AbbVie, Pharma Essentia, Ionis, Disc, Sumitomo, Karyopharm, Novartis, Geron, Keros, Blueprint, Cogent, Ono, Morphic, Jubilant, and Raythera.MSN reports honoraria\/consulting fees from Astrazeneca, Daiichi Sankyo, Gilead sciences, Janssen, Sanofi, AbbVie, Genentech, Bristol Myers Squibb, Pharmacosmos, and Pharmaessentia.JM reports research support from Incyte, BMS, SOBI, Kartos, AbbVie, Morphosys, Ajax, Geron, PharmaEssentia, Italfarmaco Spa, Karyopharm, Disc, and honoraria\/consulting fees from Incyte, BMS, SOBI, GSK, Novartis, AbbVie, PharmaEssentia, Italfarmaco Spa, Disc, Sumitomo, Karyopharm, Geron, Keros, Blueprint, and Merck.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Conflict of interests"}},{"value":"This consensus was not prospectively registered.","order":5,"name":"Ethics","group":{"name":"EthicsHeading","label":"Trial registration"}}]}}