Treatment Algorithm of Tefferi and Barbui for a Patient with Essential Trombocythemia

Overview"

Tefferi has developed a treatment algorithm for patients with essential thrombocythemia. The authors are from the Mayo Clinic in Rochester and the Ospedale Riuniti in Bergamo, Italy.

 

Basic therapy for all patients:

(1) low dose aspirin to reduce thrombosis (if no contraindications)

 

Contraindications to aspirin therapy:

(1) hypersensitivity

(2) congenital or acquired von Willbrand's disease

(3) hemophilia

(4) bleeding peptic ulcer

(5) bleeding diathesis

(6) platelet count > 1,000,000 per µL

 

Parameters for determining additional therapy:

(1) age

(2) risk category (low, intermediate/indeterminate, high)

(3) child-bearing potential for a female

 

Candidates for therapy with hydroxyurea as myelosuppressive agent:

(1) high risk AND < 60 years old AND not a woman of childbearing age

(2) age >= 60 years (high risk)

(3) indeterminate risk AND < 60 years old AND not a woman of childbearing age AND clinical indications for myelosuppression (such a platelet count > 1,500,000 per µL)

 

Candidates for interferon alfa therapy:

(1) woman of childbearing age AND high risk

 

The target platelet count with myelosuppression is the level at which there is relief from symptoms or correction of a bleeding diathesis. The platelet count does not need to be normal.

 

where:

• Radioactive phosphorus-32 and chlorambucil are not used for myelosuppression because of the risk of acute leukemia.

• I would imagine another antiplatelet agent might be considered if aspirin is contraindicated.