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While many remain within the clinical trial arena, the clinician and patient community have seen more approvals reaching the clinic and a rethink on how best we should be approaching these disorders is required. In parallel, there needs to be a paradigm shift in end\u2010point considerations within MPN clinical trial design, with a growing emphasis on longer term disease stability and modification, molecular responses, histomorphological modification, reductions in complications (e.g. thrombotic complications or disease transformation) and improved survival alongside the conventional goals such as haematological responses and symptom and spleen improvements where relevant. Given the heterogeneity of these disorders, with often marked intrapatient variability, greater consideration must be given to optimised sequencing strategies and rational combination approaches and, importantly, an emphasis on patient\u2010specific trajectories. In this review, we appraise the contemporary therapeutic armamentarium across the MPN spectrum and explore how these advances may best facilitate increasing personalised approaches in an evolving and complex treatment landscape.<\/jats:p>","DOI":"10.1111\/bjh.70672","type":"journal-article","created":{"date-parts":[[2026,7,9]],"date-time":"2026-07-09T08:44:11Z","timestamp":1783586651000},"page":"1450-1468","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Integrating novel therapeutic strategies in myeloproliferative neoplasms: Driving disease\u2010directed progress"],"prefix":"10.1111","volume":"209","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-9124-8981","authenticated-orcid":false,"given":"Trung Q.","family":"Ngo","sequence":"first","affiliation":[{"name":"Department of Haematology University College London Hospitals NHS Foundation Trust  London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0007-3144-6741","authenticated-orcid":false,"given":"Maria","family":"Georgiou","sequence":"additional","affiliation":[{"name":"Department of Haematology Guy's and St. Thomas' NHS Foundation Trust  London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1224-091X","authenticated-orcid":false,"given":"Donal P.","family":"McLornan","sequence":"additional","affiliation":[{"name":"Department of Haematology University College London Hospitals NHS Foundation Trust  London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3212-920X","authenticated-orcid":false,"given":"Claire N.","family":"Harrison","sequence":"additional","affiliation":[{"name":"Department of Haematology Guy's and St. Thomas' NHS Foundation Trust  London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,7,9]]},"reference":[{"key":"e_1_2_13_2_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1716614"},{"key":"e_1_2_13_3_1","doi-asserted-by":"publisher","DOI":"10.1182\/blood-2016-10-695940"},{"key":"e_1_2_13_4_1","doi-asserted-by":"publisher","DOI":"10.1080\/10428194.2018.1480768"},{"key":"e_1_2_13_5_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0025-6196(11)62964-9"},{"key":"e_1_2_13_6_1","doi-asserted-by":"publisher","DOI":"10.1038\/s41408-025-01235-7"},{"key":"e_1_2_13_7_1","doi-asserted-by":"publisher","DOI":"10.1002\/cncr.34205"},{"key":"e_1_2_13_8_1","doi-asserted-by":"publisher","DOI":"10.1111\/bjh.70260"},{"key":"e_1_2_13_9_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1365-2141.2010.08122.x"},{"key":"e_1_2_13_10_1","doi-asserted-by":"publisher","DOI":"10.1111\/bjh.12986"},{"key":"e_1_2_13_11_1","doi-asserted-by":"publisher","DOI":"10.1182\/blood.2022017625"},{"key":"e_1_2_13_12_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.leukres.2022.106962"},{"key":"e_1_2_13_13_1","doi-asserted-by":"publisher","DOI":"10.1016\/S2352-3026(25)00264-9"},{"key":"e_1_2_13_14_1","doi-asserted-by":"publisher","DOI":"10.1182\/blood-2025-485"},{"key":"e_1_2_13_15_1","doi-asserted-by":"publisher","DOI":"10.1182\/blood-2013-01-478891"},{"key":"e_1_2_13_16_1","doi-asserted-by":"publisher","DOI":"10.1182\/blood-2025-1024"},{"key":"e_1_2_13_17_1","doi-asserted-by":"publisher","DOI":"10.1007\/s12672-025-03703-9"},{"key":"e_1_2_13_18_1","doi-asserted-by":"publisher","DOI":"10.1200\/JCO.22.01935"},{"key":"e_1_2_13_19_1","doi-asserted-by":"publisher","DOI":"10.1182\/blood.2023022418"},{"key":"e_1_2_13_20_1","doi-asserted-by":"publisher","DOI":"10.1016\/S2352-3026(22)00046-1"},{"key":"e_1_2_13_21_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1409002"},{"key":"e_1_2_13_22_1","doi-asserted-by":"publisher","DOI":"10.1016\/S2352-3026(19)30207-8"},{"key":"e_1_2_13_23_1","unstructured":"A Phase III Randomised Open\u2010label Multicenter International Trial Comparing Ruxolitinib With Either HydRoxycarbamIDe or Interferon Alpha as First Line ThErapy for High Risk Polycythemia Vera [Internet].2019. 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