Srdan Verstovsek, MD:Our patient, who is younger than age 60 and has never had a thrombotic episode, is at low risk for thrombosis among the population of patients with polycythemia vera. Our patient was properly started on therapy with low-dose aspirin (81 mg) and phlebotomy with a goal to decrease the hematocrit level to below 45%. Now, a few months later, the patient is back in our office with continuous requirements for phlebotomies and continuous presence of general symptoms. This would be reflective of uncontrolled red blood cell count, or, in other words, uncontrolled polycythemia vera. One needs to remember that we are talking about a person, not just about controlling a number. We control the number to decrease the risk of thrombosis to save the life of the patient but also to improve their quality of life. So, there is a goal to control thrombotic risk. A secondary goal of therapy for polycythemia vera is to control the symptoms.
Despite the phlebotomies, this patient is still symptomatic. In this case, it is very reasonable to say that something else needs to be done. If the phlebotomies are not controlling the symptoms, and the control of the blood cell count does not project into improvement in quality of life, then one needs to think about the introduction of cytoreductive therapy. Cytoreductive therapy is treatment that works to control the blood cell count without allowing the blood cell count to go up and down.
Basically, phlebotomy is introduced when the number is high. Then you lower it. Then it goes up. Then you lower it with phlebotomies. So, it goes up and down and up and down. The symptoms are obviously not very well controlled if you allow a time period when the blood cell count is high. Cytoreductive therapy will level it off and keep the number low all the time. This will likely result in better control of the symptoms. So, in our particular case, although the patient is at low risk for thrombosis, it is reasonable to introduce cytoreductive therapy. I would introduce hydroxyurea as a first-line option.
Transcript edited for clarity.
June 2016
October 2016
January 2017
Connecting Spleen Volume Reduction to Survival Outcomes in MF
April 21st 2024During a Case-Based Roundtable® event, Raajit K. Rampal, MD, PhD, discussed the correlation between spleen volume responses and survival outcomes for patients with myelofibrosis in the second article of a 2-part series.
Read More
Savona Discusses First-Line JAK Inhibition for Patients With Myelofibrosis at Risk of Anemia
April 17th 2024During a Case-Based Roundtable® event, Michael Savona, MD, and participants discussed the case of a patient with myelofibrosis and moderate anemia receiving JAK inhibitor therapy.
Read More
PTCy Offers New Hope for Mismatched Stem Cell Transplants in Leukemia, MDS
April 13th 2024Jeff Auletta, MD, discussed how PTCy-based graft-vs-host disease prophylaxis offers a promising approach for expanding access to successful cell transplantation regardless of donor match or patient ethnicity.
Read More
Scott Evaluates Treatment Options for Hydroxyurea-Resistant Polycythemia Vera
March 28th 2024In a Community Case Forum event in partnership with the Washington State Medical Oncology Society, Bart Scott, MD, broke down various trials of hydroxyurea, ruxolitinib, and interferon in patients with polycythemia vera to assess outcomes such as hematocrit control and molecular response.
Read More