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Recent research highlights significant advancements in myelofibrosis treatments, particularly with the IMPROVE-MF trial, which investigates the combination of amethylstat and roxalitinib for patients with suboptimal responses to roxalitinib alone. Findings suggest that higher doses of imetelstat may lead to improved patient survival, indicating potential disease-modifying properties particularly targeting malignant hematopoietic stem cells. Similarly, a novel approach involves utilizing regulatory T-cells alongside ruxolitinib to address persistent inflammatory pathways impacting treatment effectiveness. Preliminary results have shown positive safety profiles and symptom improvement across various phases of these trials, propelling the momentum for further investigation.