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Palumbo GA, Breccia M, Baratè C, Bonifacio M, Elli EM, Iurlo A, Pugliese N, Rossi E, Guglielmelli P, Palandri F. Management of polycythemia vera: A survey of treatment patterns in Italy. Eur J Haematol 2023; 110:161-167. [PMID: 36319575 PMCID: PMC10100449 DOI: 10.1111/ejh.13889] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Revised: 10/24/2022] [Accepted: 10/26/2022] [Indexed: 11/07/2022]
Abstract
OBJECTIVES Polycythemia vera (PV) is an acquired clonal hematopoietic stem cell disorder characterized by the overproduction of red blood cells. It has long been underlined that there are differences in treatment patterns in routine practice. Therapeutic strategies have also expanded, and in recent years the JAK1/JAK2 inhibitor ruxolitinib has emerged as a second-line therapeutic option in patients who are intolerant to or resistant to hydroxyurea. Determining the impact of changes on practice patterns is of interest, especially for aspects that lack detailed guidance for management. METHODS To gain insights into treatment patterns by clinicians treating patients with PV in Italy, we carried out a survey of 60 hematologists and transfusion specialists. The questions covered: treatment of low-risk patients, definition of significant leukocytosis, splenomegaly and excessive phlebotomies, resistance/intolerance to hydroxyurea, use of ruxolitinib, cytoreductive therapy, and vaccines. RESULTS In general, the results of the survey indicate that there is a large heterogeneity in management of patients with PV across these areas. CONCLUSIONS While helping to provide greater understanding of treatment patterns for patients with PV in Italy, our survey highlights the need for additional clinical studies to obtain more precise guidance for the routine care of patients with PV.
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Affiliation(s)
- Giuseppe Alberto Palumbo
- Dipartimento di Scienze Mediche, Chirurgiche e Tecnologie Avanzate "G.F. Ingrassia", University of Catania, Catania, Italy
| | - Massimo Breccia
- Hematology, Department of Precision and Translational Medicine, Policlinico Umberto 1, Sapienza University, Rome, Italy
| | - Claudia Baratè
- Department of Clinical and Experimental Medicine, Section of Hematology, University of Pisa, Pisa, Italy
| | - Massimiliano Bonifacio
- Department of Medicine, Section of Hematology, University of Verona and AOUI Verona, Verona, Italy
| | - Elena Maria Elli
- Hematology Division and Bone Marrow Transplant Unit, Ospedale San Gerardo, ASST Monza, Monza, Italy
| | - Alessandra Iurlo
- Hematology Division, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Novella Pugliese
- Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy
| | - Elena Rossi
- Section of Hematology, Department of Radiological and Hematological Sciences, Catholic University, Fondazione Policlinico A. Gemelli IRCCS, Rome, Italy
| | - Paola Guglielmelli
- Center of Research and Innovation of Myeloproliferative Neoplasms, AOU Careggi, University of Florence, Florence, Italy
| | - Francesca Palandri
- IRCCS Azienda Ospedaliero-Universitaria di Bologna, Istituto di Ematologia "Seràgnoli", Bologna, Italy
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Slaninova N, Bryjova I, Lasota Z, Richterova R, Kubicek J, Augustynek M, Seal A, Krejcar O, Proto A. Thrombotic and Atherogenetic Predisposition in Polyglobulic Donors. Biomedicines 2022; 10:biomedicines10040888. [PMID: 35453637 PMCID: PMC9027744 DOI: 10.3390/biomedicines10040888] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Revised: 03/31/2022] [Accepted: 04/07/2022] [Indexed: 02/04/2023] Open
Abstract
This work analyses the results of research regarding the predisposition of genetic hematological risks associated with secondary polyglobulia. The subjects of the study were selected based on shared laboratory markers and basic clinical symptoms. JAK2 (Janus Kinase 2) mutation negativity represented the common genetic marker of the subjects in the sample of interest. A negative JAK2 mutation hypothetically excluded the presence of an autonomous myeloproliferative disease at the time of detection. The parameters studied in this work focused mainly on thrombotic, immunological, metabolic, and cardiovascular risks. The final goal of the work was to discover the most significant key markers for the diagnosis of high-risk patients and to exclude the less important or only complementary markers, which often represent a superfluous economic burden for healthcare institutions. These research results are applicable as a clinical guideline for the effective diagnosis of selected parameters that demonstrated high sensitivity and specificity. According to the results obtained in the present research, groups with a high incidence of mutations were evaluated as being at higher risk for polycythemia vera disease. It was not possible to clearly determine which of the patients examined had a higher risk of developing the disease as different combinations of mutations could manifest different symptoms of the disease. In general, the entire study group was at risk for manifestations of polycythemia vera disease without a clear diagnosis. The group with less than 20% incidence appeared to be clinically insignificant for polycythemia vera testing and thus there is a potential for saving money in mutation testing. On the other hand, the JAK V617F (somatic mutation of JAK2) parameter from this group should be investigated as it is a clear exclusion or confirmation of polycythemia vera as the primary disease.
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Affiliation(s)
- Nikola Slaninova
- Department of Cybernetics and Biomedical Engineering, VŠB—Technical University of Ostrava, 17. listopadu 2172/15, 708 00 Ostrava–Poruba, Czech Republic; (N.S.); (I.B.); (M.A.); (A.P.)
| | - Iveta Bryjova
- Department of Cybernetics and Biomedical Engineering, VŠB—Technical University of Ostrava, 17. listopadu 2172/15, 708 00 Ostrava–Poruba, Czech Republic; (N.S.); (I.B.); (M.A.); (A.P.)
| | - Zenon Lasota
- Blood Donor Center, tr. T. G. Masaryka 495, 738 01 Frydek-Mistek, Czech Republic; (Z.L.); (R.R.)
| | - Radmila Richterova
- Blood Donor Center, tr. T. G. Masaryka 495, 738 01 Frydek-Mistek, Czech Republic; (Z.L.); (R.R.)
| | - Jan Kubicek
- Department of Cybernetics and Biomedical Engineering, VŠB—Technical University of Ostrava, 17. listopadu 2172/15, 708 00 Ostrava–Poruba, Czech Republic; (N.S.); (I.B.); (M.A.); (A.P.)
- Correspondence:
| | - Martin Augustynek
- Department of Cybernetics and Biomedical Engineering, VŠB—Technical University of Ostrava, 17. listopadu 2172/15, 708 00 Ostrava–Poruba, Czech Republic; (N.S.); (I.B.); (M.A.); (A.P.)
| | - Ayan Seal
- Department of Computer Science & Engineering, PDPM Indian Institute of Information Technology, Design and Manufacturing, Jabalpur 482005, India;
- Center for Basic and Applied Research, Faculty of Informatics and Management, University of Hradec Kralove, Hradecka 1249, 500 03 Hradec Kralove, Czech Republic;
| | - Ondrej Krejcar
- Center for Basic and Applied Research, Faculty of Informatics and Management, University of Hradec Kralove, Hradecka 1249, 500 03 Hradec Kralove, Czech Republic;
| | - Antonino Proto
- Department of Cybernetics and Biomedical Engineering, VŠB—Technical University of Ostrava, 17. listopadu 2172/15, 708 00 Ostrava–Poruba, Czech Republic; (N.S.); (I.B.); (M.A.); (A.P.)
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3
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Palandri F, Mora B, Gangat N, Catani L. Is there a gender effect in polycythemia vera? Ann Hematol 2021; 100:11-25. [PMID: 33006021 PMCID: PMC7782364 DOI: 10.1007/s00277-020-04287-w] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Accepted: 09/07/2020] [Indexed: 12/14/2022]
Abstract
In recent times, there has been a growing interest in understanding the impact of gender on disease biology and clinical outcomes in Philadelphia-negative chronic myeloproliferative neoplasms. Among those, polycythemia vera (PV) is characterized by increased thrombotic risk, systemic symptoms, and overall reduced survival. Here, we aim to summarize data on whether and to what extent female sex can affect PV biology and outcome. To this end, we will discuss the latest acquisitions in terms of pathogenesis, diagnosis, epidemiology, clinical presentation and symptoms burden, thrombotic risk and related treatment strategies, and prognosis in female patients affected by PV.
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Affiliation(s)
- Francesca Palandri
- Azienda Ospedaliero-Universitaria di Bologna, Via Albertoni 15, Bologna, Italy
| | - Barbara Mora
- Hematology, ASST Sette Laghi, Ospedale di Circolo, Varese, Italy
| | | | - Lucia Catani
- Azienda Ospedaliero-Universitaria di Bologna, Via Albertoni 15, Bologna, Italy
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4
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From Budd-Chiari syndrome to acquired von Willebrand syndrome: thrombosis and bleeding complications in the myeloproliferative neoplasms. Blood 2020; 134:1902-1911. [PMID: 31778549 DOI: 10.1182/blood.2019001318] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2019] [Accepted: 07/08/2019] [Indexed: 12/14/2022] Open
Abstract
Thrombotic and hemorrhagic complications are prevalent in patients with essential thrombocythemia, polycythemia vera, and myelofibrosis. Given the impact on morbidity and mortality, reducing the risk of thrombosis and/or hemorrhage is a major therapeutic goal. Historically, patients have been risk stratified on the basis of traditional factors, such as advanced age and thrombosis history. However, multiple factors contribute to the thrombotic tendency, including gender, mutational profile, inflammatory stress, and abnormal cell adhesion. Management includes cardiovascular risk reduction and use of antiplatelet therapy, depending on myeloproliferative neoplasm subtype and mutational status. Anticoagulation is a mainstay of therapy for those with venous thrombosis, but practice patterns remain heterogeneous. Cytoreduction is indicated for higher-risk patients, but efficacy may depend on the involved vascular bed. Management of special situations, such as unusual site thrombosis, bleeding, the perioperative period, and pregnancy, are especially challenging. In this article, risk factors and treatment strategies for myeloproliferative neoplasm thrombosis and bleeding, including special situations, are reviewed. Insights gained from recent studies may lead to the development of a more precise risk classification and tailored therapy.
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5
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Stein BL, Martin K. From Budd-Chiari syndrome to acquired von Willebrand syndrome: thrombosis and bleeding complications in the myeloproliferative neoplasms. HEMATOLOGY. AMERICAN SOCIETY OF HEMATOLOGY. EDUCATION PROGRAM 2019; 2019:397-406. [PMID: 31808903 PMCID: PMC6913438 DOI: 10.1182/hematology.2019001318] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/13/2023]
Abstract
Thrombotic and hemorrhagic complications are prevalent in patients with essential thrombocythemia, polycythemia vera, and myelofibrosis. Given the impact on morbidity and mortality, reducing the risk of thrombosis and/or hemorrhage is a major therapeutic goal. Historically, patients have been risk stratified on the basis of traditional factors, such as advanced age and thrombosis history. However, multiple factors contribute to the thrombotic tendency, including gender, mutational profile, inflammatory stress, and abnormal cell adhesion. Management includes cardiovascular risk reduction and use of antiplatelet therapy, depending on myeloproliferative neoplasm subtype and mutational status. Anticoagulation is a mainstay of therapy for those with venous thrombosis, but practice patterns remain heterogeneous. Cytoreduction is indicated for higher-risk patients, but efficacy may depend on the involved vascular bed. Management of special situations, such as unusual site thrombosis, bleeding, the perioperative period, and pregnancy, are especially challenging. In this article, risk factors and treatment strategies for myeloproliferative neoplasm thrombosis and bleeding, including special situations, are reviewed. Insights gained from recent studies may lead to the development of a more precise risk classification and tailored therapy.
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Affiliation(s)
- Brady L Stein
- Division of Hematology/Oncology and Robert H. Lurie Comprehensive Cancer Center, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Karlyn Martin
- Division of Hematology/Oncology and Robert H. Lurie Comprehensive Cancer Center, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL
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Loscocco GG, Mannelli F, Guglielmelli P, Paoli C, Marone I, Cucci R, Coltro G, Sordi B, Albano F, Breccia M, De Stefano V, Finazzi G, Iurlo A, Martino B, Palandri F, Passamonti F, Siragusa S, Mannelli L, Fantoni D, Fazi P, Amadori S, Vignetti M, Barbui T, Vannucchi AM. Italian survey on clinical practice in myeloproliferative neoplasms. A GIMEMA Myeloproliferative Neoplasms Working Party initiative. Am J Hematol 2019; 94:E239-E242. [PMID: 31179561 DOI: 10.1002/ajh.25555] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2019] [Accepted: 06/06/2019] [Indexed: 11/10/2022]
Affiliation(s)
- Giuseppe G. Loscocco
- CRIMM, Centro di Ricerca e Innovazione per le Malattie Mieloproliferative, AOU Careggi, Dipartimento diMedicina Sperimentale Clinica, Università degli Studi Florence Italy
| | - Francesco Mannelli
- CRIMM, Centro di Ricerca e Innovazione per le Malattie Mieloproliferative, AOU Careggi, Dipartimento diMedicina Sperimentale Clinica, Università degli Studi Florence Italy
| | - Paola Guglielmelli
- CRIMM, Centro di Ricerca e Innovazione per le Malattie Mieloproliferative, AOU Careggi, Dipartimento diMedicina Sperimentale Clinica, Università degli Studi Florence Italy
| | - Chiara Paoli
- CRIMM, Centro di Ricerca e Innovazione per le Malattie Mieloproliferative, AOU Careggi, Dipartimento diMedicina Sperimentale Clinica, Università degli Studi Florence Italy
| | - Ilaria Marone
- CRIMM, Centro di Ricerca e Innovazione per le Malattie Mieloproliferative, AOU Careggi, Dipartimento diMedicina Sperimentale Clinica, Università degli Studi Florence Italy
| | | | - Giacomo Coltro
- CRIMM, Centro di Ricerca e Innovazione per le Malattie Mieloproliferative, AOU Careggi, Dipartimento diMedicina Sperimentale Clinica, Università degli Studi Florence Italy
| | - Benedetta Sordi
- CRIMM, Centro di Ricerca e Innovazione per le Malattie Mieloproliferative, AOU Careggi, Dipartimento diMedicina Sperimentale Clinica, Università degli Studi Florence Italy
| | - Francesco Albano
- Department of Emergency and Organ Transplantation (D.E.T.O.)Hematology Section, University of Bari Bari Italy
| | - Massimo Breccia
- Department of Hematology, Department of Translational and Precision MedicineSapienza University Rome Italy
| | - Valerio De Stefano
- Istituto di Ematologia, Università Cattolica Rome Italy
- IRCCSFondazione Policlinico Gemelli Rome Italy
| | - Guido Finazzi
- UOC Ematologia, ASST Papa Giovanni XXIII Bergamo Italy
| | - Alessandra Iurlo
- Hematology DivisionFoundation IRCCS Ca' Granda Ospedale Maggiore Policlinico Milan Italy
| | - Bruno Martino
- Hematology UnitAzienda Ospedaliera “Bianchi‐Melacrino‐Morelli” Reggio Calabria Italy
| | - Francesca Palandri
- Institute of Hematology “L. and A. Seràgnoli”, St. Orsola‐Malpighi University Hospital Bologna Italy
| | - Francesco Passamonti
- Hematology UnitOspedale di Circolo ‐ ASST Sette Laghi, Università degli Studi dell'Insubria Varese Italy
| | - Sergio Siragusa
- Department of Health Promotion Sciences Maternal and Infantile CareInternal Medicine and Medical Specialities, University of Palermo Italy
| | - Lara Mannelli
- CRIMM, Centro di Ricerca e Innovazione per le Malattie Mieloproliferative, AOU Careggi, Dipartimento diMedicina Sperimentale Clinica, Università degli Studi Florence Italy
| | - Duccio Fantoni
- CRIMM, Centro di Ricerca e Innovazione per le Malattie Mieloproliferative, AOU Careggi, Dipartimento diMedicina Sperimentale Clinica, Università degli Studi Florence Italy
| | | | | | | | - Tiziano Barbui
- Foundation for Clinical Research (FROM), Papa Giovanni XXIIII Hospital Bergamo Italy
| | - Alessandro M. Vannucchi
- CRIMM, Centro di Ricerca e Innovazione per le Malattie Mieloproliferative, AOU Careggi, Dipartimento diMedicina Sperimentale Clinica, Università degli Studi Florence Italy
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7
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van de Ree-Pellikaan C, de Kreuk A, Schaar CG, Beeker A, Dompeling EC, Gerrits CJH, van Houten AA, Schipperus MR, Strobbe L, Posthuma EFM, Klauke K, Westerweel PE. Treatment strategies for polycythemia vera: Observations in a Dutch "real-world" cohort study. Eur J Haematol 2019; 103:453-459. [PMID: 31298768 DOI: 10.1111/ejh.13291] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2019] [Revised: 07/03/2019] [Accepted: 07/04/2019] [Indexed: 12/26/2022]
Abstract
OBJECTIVES Assessment of "real-world" treatment strategies and outcome in Dutch polycythemia vera (PV) patients. METHODS Retrospective chart review in 150 patients with PV (WHO 2008 diagnostic criteria) from 10 major non-academic hospitals in the Netherlands. RESULTS Patients (median age 64 years, 49% male) frequently had cardiovascular risk factors (56%) and prior vascular events (31%). About 70% of patients were high-risk, based on ELN criteria. However, the majority of patients were treated with phlebotomies alone (55%). Cytoreduction with hydroxyurea (HU) was received by 44% as part of their initial therapy, with or without phlebotomies. The time to achieve the 45% hematocrit target was shortest in patients treated with phlebotomies with or without HU (125 ± 99 and 197 ± 249 days, respectively) compared to patients treated with only HU (232 ± 216 days). Leukocyte and platelet levels were lower in HU-treated patients, and ELN response targets were more often reached. During the median follow-up period of 4.1 years, 14 patients (9%) suffered a thrombotic vascular event. CONCLUSIONS In Dutch clinical practice, there is major clinical variation in treatment strategies for PV. Phlebotomizing patients shorten the time to achieve hematocrit control, while HU better controls platelet and leukocyte levels. The thrombotic vascular event rate remains clinically significant.
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Affiliation(s)
| | - Arne de Kreuk
- Department of Internal Medicine, OLVG, Amsterdam, The Netherlands
| | - Cees G Schaar
- Department of Internal Medicine, Gelre Hospital, Apeldoorn, The Netherlands
| | - Aart Beeker
- Department of Internal Medicine, Spaarne Gasthuis, Hoofddorp, The Netherlands
| | - Ellen C Dompeling
- Department of Internal Medicine, Isala Hospital, Zwolle, The Netherlands
| | - Cees J H Gerrits
- Department of Internal Medicine, Ziekenhuisgroep Twente, Hengelo, The Netherlands
| | - Anja A van Houten
- Department of Internal Medicine, Maasstad Hospital, Rotterdam, The Netherlands
| | - Martin R Schipperus
- Department of Hematology, Haga Teaching Hospital, The Hague, The Netherlands
| | - Leonie Strobbe
- Department of Internal Medicine, Gelre Hospital, Zutphen, The Netherlands
| | | | | | - Peter E Westerweel
- Department of Internal Medicine, Albert Schweitzer Hospital, Dordrecht, The Netherlands
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8
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Mondello P, Di Mirto C, Cuzzocrea S, Arrigo C, Mian M, Pitini V. Interferon Alpha Has a Strong Anti-tumor Effect in Philadelphia-negative Myeloproliferative Neoplasms. CLINICAL LYMPHOMA MYELOMA & LEUKEMIA 2019; 19:e489-e495. [PMID: 31231012 DOI: 10.1016/j.clml.2019.03.027] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/21/2019] [Revised: 03/12/2019] [Accepted: 03/25/2019] [Indexed: 01/29/2023]
Abstract
BACKGROUND Despite the important progress in the research of myeloproliferative neoplasms (MPN), treatment options are still limited. Currently, a cytoreductive approach is the backbone treatment, with hydroxyurea (HU) being the most important agent. However, this drug is not always well-tolerated and has been questionably linked to a potential leukemogenic effect. A valid alternative is interferon alfa (IFN-α), but it is reserved for selected patients owing to the more frequent side effects and the lack of final results from the studies directly comparing IFN-α with HU, which is why we provided the results of the so far largest real-life analysis. PATIENTS AND METHODS From 2000 to 2016, 63 patients with Philadelphia-negative MPN prospectively received either HU or IFN-α. RESULTS During a median follow-up period of 121 months (range, 88-168 months), 97% of the patients treated with IFN-α achieved a hematologic response (60% complete, 37% partial) compared with 78% in the HU group (56% complete, 20% partial; P < .01). Molecular responses were limited to patients treated with IFN-α. IFN-α was well-tolerated with no secondary malignancy, whereas HU was associated with more toxic events and cases of leukemic transformation. A significantly longer progression-free survival (5.0 vs. 3.1 years; P < .001) and overall survival (7.8 vs. 5.8 years; P = .006) were observed in the IFN-α group compared with the HU cohort. CONCLUSION Our data support IFN-α as a more valid therapeutic option owing to its more profound hematologic responses, durable molecular remissions, long-term disease control, and reduced risk of leukemic transformation with a favorable toxicity profile.
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Affiliation(s)
- Patrizia Mondello
- Department of Medicine, Division of Hematology and Medical Oncology, Weill Cornell Medical College, New York, NY; Department of Human Pathology, University of Messina, Messina, Italy; Department of Biological and Environmental Sciences, University of Messina, Messina, Italy.
| | - Cristian Di Mirto
- Department of Human Pathology, University of Messina, Messina, Italy
| | - Salvatore Cuzzocrea
- Department of Biological and Environmental Sciences, University of Messina, Messina, Italy
| | - Carmela Arrigo
- Department of Human Pathology, University of Messina, Messina, Italy
| | - Michael Mian
- Internal Medicine V, Hematology and Oncology, Medical University of Innsbruck, Innsbruck, Austria; Department of Hematology and CBMT, Ospedale di Bolzano, Bolzano, Italy
| | - Vincenzo Pitini
- Department of Human Pathology, University of Messina, Messina, Italy
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9
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Habib LA, Kuo KHM, Panzarella T, Gupta V, Trinkaus M. Management of Polycythemia Vera: A Survey of Canadian Physician Practice Patterns. CLINICAL LYMPHOMA, MYELOMA & LEUKEMIA 2018; 19:e37-e42. [PMID: 30322792 DOI: 10.1016/j.clml.2018.07.297] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/09/2018] [Revised: 07/21/2018] [Accepted: 07/27/2018] [Indexed: 11/19/2022]
Abstract
BACKGROUND The 2016 World Health Organization (WHO) revised classification criteria for the diagnosis of polycythemia vera (PV) allows for an earlier detection of masked PV. The literature is scarce about the clinical uptake of new diagnostic algorithms for PV. In a cohort of Canadian hematologists, we aimed to identify how the revised 2016 WHO diagnostic criteria of PV are being incorporated into hematology practice, and if the treatment of PV is comparable to the approaches outlined by the Canadian Myeloproliferative Neoplasm Group. MATERIALS AND METHODS A cross-sectional survey of practicing Canadian hematologists/oncologists was distributed to active members of the Canadian Hematology Society using an online survey-distributing website. Univariate and multivariate analysis was performed. RESULTS The survey was completed by 86 respondents in total. Only type of practice was associated with respondents offering aspirin to all patients with PV (P = .0009). Respondents who were aware of the Canadian Myeloproliferative Neoplasm Group guidelines were more likely to phlebotomize patients to a target hematocrit of < 45% irrespective of gender (P = .042). Younger practitioners were more likely to use age over 60 years as an indication for initiating cytoreductive therapy (P = .0006). Most (85.3%) respondents would recommend indefinite anticoagulation in patients with PV who developed unprovoked venous thromboembolism. CONCLUSION The survey confirmed that heterogeneity of practice in diagnosis and management of PV among Canadian hematologists exists, suggesting that targeted education in specific segments of the PV treatment providers may result in wider adoption of the guidelines and diagnostic criteria.
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Affiliation(s)
- Laura Anne Habib
- Toronto General Hospital, University Health Network, University of Toronto, Toronto, Canada.
| | - Kevin H M Kuo
- Toronto General Hospital, University Health Network, University of Toronto, Toronto, Canada
| | - Tony Panzarella
- Princess Margaret Hospital, University Health Network, University of Toronto, Toronto, Canada
| | - Vikas Gupta
- Princess Margaret Hospital, University Health Network, University of Toronto, Toronto, Canada
| | - Martina Trinkaus
- Division of Hematology/Oncology, St. Michael's Hospital, University of Toronto, Toronto, Canada
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10
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Jackson Chornenki NL, Chai-Adisaksopha C, Leong DP, Siegal DM, Hillis CM. The real-world outcomes of treating Polycythemia Vera: Physician adherence to treatment guidelines. Leuk Res 2018; 70:62-66. [PMID: 29885533 DOI: 10.1016/j.leukres.2018.06.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2018] [Revised: 05/30/2018] [Accepted: 06/01/2018] [Indexed: 01/18/2023]
Abstract
Therapy in Polycythemia Vera (PV), a myeloproliferative neoplasm, focuses on reducing cardiovascular (CV) risk without increasing bleeding or hematological progression. However, the real-world practice of treating PV in North America is understudied. We performed a retrospective cohort study of newly diagnosed PV (JAK2V617F mutation positive) patients in Hamilton, Canada to fill this knowledge gap. Out of 108 patients included, (n = 45, 41.7%) patients did not receive therapy consistent with contemporary treatment guidelines. Multivariable analysis showed increased white blood cell count at diagnosis (HR, 1.09; 95% CI, 1.04-1.14; p < 0.001), older age (HR, 1.15; 95% CI, 1.07-1.23; p < 0.001) and diabetic history (HR, 3.71; 95% CI, 1.27-10.78; p = 0.012) associated with greater mortality. Not receiving pharmacological treatment according to guidelines was also independently associated with increased mortality (HR, 3.12; 95% CI, 1.13-8.65; p = 0.029).
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Affiliation(s)
| | | | - Darryl P Leong
- McMaster University, Hamilton, Ontario, Canada; Population Health Research Institute, Hamilton, Ontario, Canada
| | - Deborah M Siegal
- McMaster University, Hamilton, Ontario, Canada; Population Health Research Institute, Hamilton, Ontario, Canada
| | - Christopher M Hillis
- McMaster University, Hamilton, Ontario, Canada; Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada
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11
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Vannucchi AM, Guglielmelli P. What are the current treatment approaches for patients with polycythemia vera and essential thrombocythemia? HEMATOLOGY. AMERICAN SOCIETY OF HEMATOLOGY. EDUCATION PROGRAM 2017; 2017:480-488. [PMID: 29222296 PMCID: PMC6142598 DOI: 10.1182/asheducation-2017.1.480] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/13/2023]
Abstract
Polycythemia vera (PV) and essential thrombocythemia (ET) are chronic myeloproliferative neoplasms that are characterized by thrombohemorrhagic complications, symptom burden, and impaired survival mainly due to thrombosis, progression to myelofibrosis, and transformation to acute leukemia. In this manuscript, we will review the most recent changes in diagnostic criteria, the improvements in risk stratification, and the "state of the art" in the daily management of these disorders. The role of conventional therapies and novel agents, interferon α and the JAK2 inhibitor ruxolitinib, is critically discussed based on the results of a few basic randomized clinical studies. Several unmet needs remain, above all, the lack of a curative approach that might overcome the still burdensome morbidity and mortality of these hematologic neoplasms, as well as the toxicities associated with therapeutic agents.
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Affiliation(s)
- Alessandro M Vannucchi
- Center of Research and Innovation of Myeloproliferative Neoplasms (CRIMM), Careggi University Hospital/University of Florence, Florence, Italy
| | - Paola Guglielmelli
- Center of Research and Innovation of Myeloproliferative Neoplasms (CRIMM), Careggi University Hospital/University of Florence, Florence, Italy
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