Polycythemia medical therapy

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Debduti Mukhopadhyay, M.B.B.S[2]Zaida Obeidat, M.D.


Indications for use include poor venous access, high phlebotomy requirement, when phlebotomy is contraindicated or not possible, severe thrombocytosis, and unmanageable pruritus.

  • Management of pruritus: antihistamines and selective serotonin reuptake inhibitors (SSRIs) are usually used to relief the symptoms, narrow band ultraviolet-B phototherapy can also be used to treat pruritus.[3]


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

  1. Spivak JL (2019). "How I treat polycythemia vera". Blood. 134 (4): 341–352. doi:10.1182/blood.2018834044. PMID 31151982.
  2. Harrison C, Kiladjian JJ, Al-Ali HK, Gisslinger H, Waltzman R, Stalbovskaya V; et al. (2012). "JAK inhibition with ruxolitinib versus best available therapy for myelofibrosis". N Engl J Med. 366 (9): 787–98. doi:10.1056/NEJMoa1110556. PMID 22375970.
  3. Madkan VK, Bandow GD, Koo JY (2005). "Resolution of pruritus secondary to polycythemia vera in a patient treated with narrow-band ultraviolet B phototherapy". J Dermatolog Treat. 16 (1): 56–7. doi:10.1080/09546630410024529. PMID 15897170.
  4. 4.0 4.1 Stuart BJ, Viera AJ (2004). "Polycythemia vera". Am Fam Physician. 69 (9): 2139–44. PMID 15152961.

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