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Diagnosis requires assessing complete cell blood counts, bone marrow morphology, deep genetic evaluations, and disease history. Driver molecular events consist of JAK2V617F, CALR, and MPL mutations, whereas about 8% to 10% of MF are \u201ctriple-negative.\u201d Additional myeloid-gene variants are described in roughly 80% of patients. Currently available clinical-based and integrated clinical\/molecular-based scoring systems predict the survival of patients with MF and are applied for conventional treatment decision-making, indication to stem cell transplant (SCT) and allocation in clinical trials.\u00a0Standard treatment consists of anemia-oriented therapies, hydroxyurea, and JAK inhibitors such as ruxolitinib, fedratinib, and pacritinib. Overall, spleen volume reduction of 35% or greater at week 24 can be\u00a0achieved by 42% of ruxolitinib-, 47% of fedratinib-, 19% of pacritinib-, and 27% of momelotinib-treated patients. Now, it is time to move towards new paradigms for evaluating efficacy like disease modification, that we intend as a robust and unequivocal effect on disease biology and\/or on patient survival. The growing number of clinical trials potentially pave the way for new strategies in patients with MF. Translational studies of some molecules showed an early effect on bone marrow fibrosis and on variant allele frequencies of myeloid genes. SCT is still the only curative option, however, it is associated with relevant challenges. This review focuses on the diagnosis, prognostication, and treatment of MF.<\/jats:p>","DOI":"10.1182\/blood.2022017423","type":"journal-article","created":{"date-parts":[[2022,11,23]],"date-time":"2022-11-23T18:58:03Z","timestamp":1669229883000},"page":"1954-1970","update-policy":"https:\/\/doi.org\/10.1182\/blood.2019cm0000","source":"Crossref","is-referenced-by-count":157,"title":["Myelofibrosis"],"prefix":"10.1182","volume":"141","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-8068-5289","authenticated-orcid":false,"given":"Francesco","family":"Passamonti","sequence":"first","affiliation":[{"name":"1Department of Medicine and Surgery, University of Insubria, Varese, Italy"},{"name":"2Department of Oncology, ASST Sette Laghi, Ospedale di Circolo, Varese, 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