Tremblay on the Use of Cytoreductive Therapy in PV and ET

Douglas Tremblay, MD, assistant professor of medicine at the Icahn School of Medicine at Mount Sinai, discusses the use of cytoreductive therapy and potential benefits and risks of cytoreduction for patients with essential thrombocytopenia (ET) and polycythemia vera (PV).

According to Tremblay, the primary approach that is used to prevent thrombosis in certain disease states involves cytoreductive therapy. This is particularly true for patients at high-thrombotic-risk or patients who have symptoms that may be alleviated by such treatment.

Some of the current approved treatment options for cytoreduction in ET and PV include hydroxyurea and long-acting interferons for both, as well as anagrelide (Agrylin) for ET, and ruxolitinib (Jakafi) for PV.

Transcription:

0:10 | Cytoreductive therapy refers to multiple medications which are given with the purpose of reducing blood counts in both essential thrombocythemia and polycythemia vera, but are also given for the purpose of reducing thrombotic risk. Thrombosis is the leading cause of morbidity and mortality in patients with polycythemia vera and essential thrombocytopenia, and these medications are given in order to mitigate that risk.

0:35 | Cytoreductive therapy is given in order to reduce thrombotic risk, and that's really its purpose. It is associated with some [adverse] effects in different medications, including hydroxyurea, pegylated interferon, anagrelide for ET, or ruxolitinib for PV, [which] have unique [adverse] effect profiles, but they all carry some risks and [adverse] effects. They're not curative therapies. They are really done to reduce risk of thrombosis and therefore, it is important to understand what someone's baseline risk is for thrombosis, that way you can decide if the benefits of cytoreductive therapy outweigh the risks in those patients.

REFERENCE:

Tremblay D. Cytoreduction for ET and PV: who, what, when, and how?. Hematology Am Soc Hematol Educ Program. 2023;2023(1):660-666. doi:10.1182/hematology.2023000451