What laboratory tests are essential for monitoring disease progression in patients diagnosed with myelofibrosis?

Essential laboratory tests for monitoring disease progression in patients diagnosed with myelofibrosis include a full blood count to assess for anemia, leukocytosis, or thrombocytopenia, which reflect marrow function and disease activity. Regular monitoring of renal function and bone profile is important to detect complications such as renal impairment and metabolic abnormalities. Serum protein electrophoresis and serum-free light-chain assay are useful to evaluate for any associated plasma cell dyscrasia or paraprotein production, which can influence prognosis and treatment decisions. Additionally, molecular testing for driver mutations (e.g., JAK2, CALR, MPL) and next-generation sequencing panels can provide prognostic information and detect clonal evolution or disease progression at the genetic level. Monitoring inflammatory markers such as erythrocyte sedimentation rate (ESR) or plasma viscosity may also be informative in some cases. Bone marrow biopsy with morphological and cytogenetic analysis remains a key tool for assessing fibrosis grade and disease progression, although it is less frequently repeated unless clinically indicated. Imaging and symptom assessment complement laboratory monitoring but are not laboratory tests per se. This integrated approach aligns with UK haematological cancer service guidance and is supported by recent literature emphasizing the role of molecular diagnostics in myeloproliferative neoplasms including myelofibrosis NICE NG35 Zuo et al. 2019.