Overview"
Tefferi has developed a treatment algorithm for patients with polycythemia vera. The author is from the Mayo Clinic in Rochester.
Basic therapy for all patients:
(1) phlebotomy to a target level (hematocrit < 45% in males; < 42% in females)
(2) low dose aspirin to reduce thrombosis (if no contraindications)
(3) SSRI (such as paroxetine) to reduce pruritis
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
Candidates for interferon alfa therapy:
(1) woman of childbearing age AND high risk
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.
Specialty: Hematology Oncology
ICD-10: ,