Polycythemia vera medical therapy: Difference between revisions
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{{Polycythemia vera}} | {{Polycythemia vera}} | ||
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==Overview== | ==Overview== | ||
The mainstay of therapy for polycythemia vera is [[phlebotomy]], [[hydroxyurea]] (alone or with phlebotomy), interferon-alpha and pegylated interferon-alpha, chlorambucil, and low-dose aspirin (≤100 mg) daily.<ref name="cancergov">National Cancer Institute. Physician Data Query Database 2015.http://www.cancer.gov/types/myeloproliferative/hp/chronic-treatment-pdq#section/_5</ref> | |||
==Medical Therapy== | ==Medical Therapy== | ||
treatment focuses on treating symptoms and reducing thrombotic complications reducing the erythrocyte levels. | |||
[[Bloodletting]] or phlebotomy is one form of treatment, which often may be combined with other therapies. The removal of blood from the body reduces the blood volume and brings down the hematocrit levels; in patients with polycythemia vera, this reduces the risk of blood clots. Phlebotomy is typically performed in people with polycythemia vera to bring their [[hematocrit]] (red blood cell percentage) down below 45 for men or 42 for women.<ref>{{cite journal |author=Streiff MB, Smith B, Spivak JL |title=The diagnosis and management of polycythemia vera in the era since the Polycythemia Vera Study Group: a survey of American Society of Hematology members' practice patterns |journal=Blood |volume=99 |issue=4 |pages=1144-9 |year=2002 |pmid=11830459}}</ref> | [[Bloodletting]] or phlebotomy is one form of treatment, which often may be combined with other therapies. The removal of blood from the body reduces the blood volume and brings down the hematocrit levels; in patients with polycythemia vera, this reduces the risk of blood clots. Phlebotomy is typically performed in people with polycythemia vera to bring their [[hematocrit]] (red blood cell percentage) down below 45 for men or 42 for women.<ref>{{cite journal |author=Streiff MB, Smith B, Spivak JL |title=The diagnosis and management of polycythemia vera in the era since the Polycythemia Vera Study Group: a survey of American Society of Hematology members' practice patterns |journal=Blood |volume=99 |issue=4 |pages=1144-9 |year=2002 |pmid=11830459}}</ref> | ||
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Revision as of 17:12, 6 November 2015
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Mohamad Alkateb, MBBCh [2]
Overview
The mainstay of therapy for polycythemia vera is phlebotomy, hydroxyurea (alone or with phlebotomy), interferon-alpha and pegylated interferon-alpha, chlorambucil, and low-dose aspirin (≤100 mg) daily.[1]
Medical Therapy
treatment focuses on treating symptoms and reducing thrombotic complications reducing the erythrocyte levels.
Bloodletting or phlebotomy is one form of treatment, which often may be combined with other therapies. The removal of blood from the body reduces the blood volume and brings down the hematocrit levels; in patients with polycythemia vera, this reduces the risk of blood clots. Phlebotomy is typically performed in people with polycythemia vera to bring their hematocrit (red blood cell percentage) down below 45 for men or 42 for women.[2]
Low dose aspirin is often prescribed. Research has shown that aspirin reduces the risk for various thrombotic complications.
Chemotherapy for polycythemia may be used sparingly, when the rate of bloodlettings required to maintain normal hematocrit is not acceptable. This is usually with a "cytoreductive agent" (hydroxyurea, also known as hydroxycarbamide).
The tendency to avoid chemotherapy if possible, especially in young patients, is due to research indicating increased risk of transformation to AML, and while hydroxyurea is considered safer in this aspect, there is still some debate about its long-term safety.
In the past, injection of radioactive isotopes was used as another means to suppress the bone marrow. Such treatment is now avoided due to a high rate of AML transformation.
Other therapies include interferon injections, and in cases where secondary thrombocytosis (high platelet count) is present, anagrelide may be prescribed.
Bone marrow transplants are rarely undertaken in polycythemia patients - since this condition is non-fatal if treated and monitored, the benefits rarely outweigh the risks involved in such a procedure.
References
- ↑ National Cancer Institute. Physician Data Query Database 2015.http://www.cancer.gov/types/myeloproliferative/hp/chronic-treatment-pdq#section/_5
- ↑ Streiff MB, Smith B, Spivak JL (2002). "The diagnosis and management of polycythemia vera in the era since the Polycythemia Vera Study Group: a survey of American Society of Hematology members' practice patterns". Blood. 99 (4): 1144–9. PMID 11830459.