Factors in Selecting Initial PV Therapy

Opinion
Video

Dr. Kuykendall explains the factors he considers when deciding on initial therapy for advanced PV patients, including comorbidities, individual patient factors like age and symptoms, and weighing the risks and benefits of different treatment options.

Case: Management of Advanced Polycythemia Vera in a 67-Year-Old-Male

Clinical Presentation:

  • 67-year-old male presented with frequent headache and dizziness
  • Prior medical history is notable for smoking.
  • PMH: unremarkable, no splenomegaly

Initial Clinical Workup and Diagnosis:

  • Labs:
    • Hemoglobin, 20.5 g/dL
    • White blood cell count, 13 K/L
    • Platelet count, 380 K/L
    • Hematocrit, 68%
  • JAK2-V617F mutation- variant allele frequency of 65%
  • Bone marrow biopsy: trilineage proliferation and pleiomorphic megakaryocytes
  • The patient started phlebotomy, aspirin, and Hydroxyurea (HU)

Initial Treatments:

  • The patient started phlebotomy, aspirin and HU.
    • Over the next year the patient underwent several phlebotomies and remained on aspirin and 2000 mg/day of HU

Disease Progression and Subsequent Treatments:

February 2019

  • 2 phlebotomies since the last visit 3 months earlier
  • He is also experiencing fatigue and night sweats.
  • Labs
    • Hgb, 15.5 g/dL
    • WBC, 13 K/L
    • Platelet count, 380 K/L
    • Hematocrit, 47%
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