Tremblay's Approach to Cytoreduction Across MPNs

Douglas Tremblay, MD, assistant professor of medicine at the Icahn School of Medicine at Mount Sinai, discusses the factors which influence the decision to recommend cytoreduction for patients with essential thrombocytopenia (ET) and polycythemia vera (PV).

According to Tremblay, deciding when to start cytoreductive therapy in patients with chronic myeloproliferative neoplasms (MPN) patients like those with PV and ET hinges on accurate risk assessment. While risk stratification tools like the European LeukemiaNet (ELN) classification or the IPSET-Thrombosis score are valuable, Tremblay cautions against oversimplifying things.

He also emphasizes that different factors can indicate which patients are high-risk, including biological age and individual cardiovascular risk factors. Overall, utilizing a personalized approach to risk assessment is key when deciding on cytoreductive therapy for patients with MPN patients. Age should be considered within the context of their overall health and potential for vascular complications. With a personalized approach, experts can ensure that cytoreductive therapy is reserved for those who truly stand to benefit and avoids unnecessary treatment for others.

Transcription:

0:09 | The discussion around when to start cytoreductive therapy around chronic MPN patients with PV and ET really has to do around risk stratification. There are risk stratification schemas available, largely used through the ELN risk classification, which dictates high-risk patients older than the age of 60, or those who have a prior thrombosis. In ET, there are additional risk stratification schemas, including the IPSET-Thrombosis and the revised subset thrombosis score. These can dictate which patients are high-risk for thrombosis and then who will be benefiting from cytoreductive therapy.

0:46 | But many of these different factors exist on a continuum, such as age in particular, and what I highlighted in my talk is that there is not a difference in your risk stratification the day that you turn 61 years old, and it is very important to understand someone's biological age, including their cardiovascular risk factors that can inform their overall risk of having a blood clot in these diseases.