Polycythemia medical therapy: Difference between revisions
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| style="padding: 0 5px; background: #F5F5F5; text-align: left;" | Erythromelalgia | | style="padding: 0 5px; background: #F5F5F5; text-align: left;" | Erythromelalgia | ||
| style="padding: 0 5px; background: #F5F5F5; text-align: left;" | Aspirin, 50 to 100 mg daily<br>Myelosuppressive agents | | style="padding: 0 5px; background: #F5F5F5; text-align: left;" | Aspirin, 50 to 100 mg daily<br>Myelosuppressive agents | ||
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'''Myelosuppressive Agents for the Treatment of Polycythemia Vera'''<ref name="pmid15152961">{{cite journal| author=Stuart BJ, Viera AJ| title=Polycythemia vera. | journal=Am Fam Physician | year= 2004 | volume= 69 | issue= 9 | pages= 2139-44 | pmid=15152961 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15152961 }} </ref> | |||
{| style="border: 2px solid #4479BA; align="left" | |||
! style="width: 200px; background: #4479BA;" | {{fontcolor|#FFF|Agent}} | |||
! style="width: 300px; background: #4479BA;" | {{fontcolor|#FFF|Class}} | |||
! style="width: 400px; background: #4479BA;" | {{fontcolor|#FFF|Common side effects}} | |||
! style="width: 500px; background: #4479BA;" | {{fontcolor|#FFF|Uncommon side effects}} | |||
! style="width: 600px; background: #4479BA;" | {{fontcolor|#FFF|Percautions}} | |||
|- | |||
| style="padding: 0 5px; background: #F5F5F5; text-align: left;" | Hydroxyurea (Hydrea) | |||
| style="padding: 0 5px; background: #F5F5F5; text-align: left;" | Antimetabolite | |||
| style="padding: 0 5px; background: #F5F5F5; text-align: left;" | Anemia, neutropenia, oral ulcers, skin ulcers, hyperpigmentation, nail changes | |||
| style="padding: 0 5px; background: #F5F5F5; text-align: left;" | Leg ulcers, nausea, diarrhea, fever, elevated liver function test results | |||
| style="padding: 0 5px; background: #F5F5F5; text-align: left;" | Renal disease | |||
|- | |||
| style="padding: 0 5px; background: #F5F5F5; text-align: left;" | Recombinant interferon alfa-2b (Intron A) | |||
| style="padding: 0 5px; background: #F5F5F5; text-align: left;" | Myelosuppressive | |||
| style="padding: 0 5px; background: #F5F5F5; text-align: left;" | Influenza-like symptoms, fatigue, anorexia, weight loss, alopecia, headache, nausea, insomnia, body pain | |||
| style="padding: 0 5px; background: #F5F5F5; text-align: left;" | Confusion, depression, autoimmunity, hyperlipidemia | |||
| style="padding: 0 5px; background: #F5F5F5; text-align: left;" | Psychiatric disease, cardiovascular disease | |||
|- | |||
| style="padding: 0 5px; background: #F5F5F5; text-align: left;" | Radioactive phosphorus | |||
| style="padding: 0 5px; background: #F5F5F5; text-align: left;" | Radiopharmaceutica | |||
| style="padding: 0 5px; background: #F5F5F5; text-align: left;" | Anemia, thrombocytopenia, leukopenia, Leukemia may develop after treatment | |||
| style="padding: 0 5px; background: #F5F5F5; text-align: left;" | Diarrhea, fever, nausea, emesis | |||
| style="padding: 0 5px; background: #F5F5F5; text-align: left;" | — | |||
|- | |||
| style="padding: 0 5px; background: #F5F5F5; text-align: left;" | Busulfan (Myleran) | |||
| style="padding: 0 5px; background: #F5F5F5; text-align: left;" | Alkylating agent | |||
| style="padding: 0 5px; background: #F5F5F5; text-align: left;" | Pancytopenia, hyperpigmentation, ovarian suppression | |||
| style="padding: 0 5px; background: #F5F5F5; text-align: left;" | Pulmonary fibrosis, leukemia, seizure, hepatic veno-occlusion | |||
| style="padding: 0 5px; background: #F5F5F5; text-align: left;" | Seizure disorder | |||
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Revision as of 16:27, 16 December 2020
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Polycythemia Microchapters |
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Diagnosis |
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Treatment |
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Case Studies |
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Polycythemia medical therapy On the Web |
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American Roentgen Ray Society Images of Polycythemia medical therapy |
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Risk calculators and risk factors for Polycythemia medical therapy |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Debduti Mukhopadhyay, M.B.B.S[2]
Overview
- Phlebotomy: the backbone of therapy, treatment with phlebotomy alone associated with a longer median survival compared to the use of chlorambucil or radioactive phosphorous based on a trial conducted by PV study group. Repeated phlebotomies help in cytoreduction and reduce hyper-viscosity in addition to induce a state of iron-deficiency which can help retard red-cell proliferation. Weekly sessions are conducted, by remove 500ml of blood until a target hematocrit of under 45% is obtained. This can lower rates of cardiovascular deaths and major thrombotic episodes in patients kept under this threshold based on a trial conducted in Italy. For secondary polycythemias, phlebotomy is usually reserved for the following conditions:
- Medicines that may be used include:[3]
- Hydroxyurea: it used to reduce red blood cells counts and other blood cells if high. It also used to prevent thrombosis in patients >60 years of age with chronic PV.
- Interferon: reduce blood cell counts.PegIFN can be used to reduce established splenomegaly but not usually to normal size.
- Anagrelide: used to treat thrombocytosis.
- Ruxolitinib (JAK1/2 inhibitor): proved to be effective in PPMF and chronic-phase PV; provided durable symptom relief, blood count control, and reduction in splenomegaly; and was superior to hydroxyurea.
- Aspirin: used to prevent thrombosis.
- Ultraviolet-B light therapy: reduce the itchiness.
Sumptomatic Treatment in Polycythemia Vera[4]
| Symptoms | Treatment |
|---|---|
| Pruritus | H1 and H2 blocking antihistamines (diphenhydramine [Benadryl], cyproheptadine [Periactin], hydroxyzine [Atarax, Vistaril], fexofenadine [Allegra], terfenadine [Seldane]) Paroxetine (Paxil) Oatmeal or starch baths (in lukewarm water) Recombinant interferon alfa-2b (intronA) |
| Erythromelalgia | Aspirin, 50 to 100 mg daily Myelosuppressive agents |
Myelosuppressive Agents for the Treatment of Polycythemia Vera[4]
| Agent | Class | Common side effects | Uncommon side effects | Percautions |
|---|---|---|---|---|
| Hydroxyurea (Hydrea) | Antimetabolite | Anemia, neutropenia, oral ulcers, skin ulcers, hyperpigmentation, nail changes | Leg ulcers, nausea, diarrhea, fever, elevated liver function test results | Renal disease |
| Recombinant interferon alfa-2b (Intron A) | Myelosuppressive | Influenza-like symptoms, fatigue, anorexia, weight loss, alopecia, headache, nausea, insomnia, body pain | Confusion, depression, autoimmunity, hyperlipidemia | Psychiatric disease, cardiovascular disease |
| Radioactive phosphorus | Radiopharmaceutica | Anemia, thrombocytopenia, leukopenia, Leukemia may develop after treatment | Diarrhea, fever, nausea, emesis | — |
| Busulfan (Myleran) | Alkylating agent | Pancytopenia, hyperpigmentation, ovarian suppression | Pulmonary fibrosis, leukemia, seizure, hepatic veno-occlusion | Seizure disorder |
References
- ↑ Assi TB, Baz E (2014). "Current applications of therapeutic phlebotomy". Blood Transfus. 12 Suppl 1: s75–83. doi:10.2450/2013.0299-12. PMC 3934278. PMID 24120605.
- ↑ "StatPearls". 2020. PMID 30252337.
- ↑ Spivak JL (2019). "How I treat polycythemia vera". Blood. 134 (4): 341–352. doi:10.1182/blood.2018834044. PMID 31151982.
- ↑ 4.0 4.1 Stuart BJ, Viera AJ (2004). "Polycythemia vera". Am Fam Physician. 69 (9): 2139–44. PMID 15152961.