Dr. Hoffman on the Current Polycythemia Vera Treatment Paradigm

Ronald Hoffman, MD, professor of medicine, hematology, and medical oncology and director of the Myeloproliferative Diseases Program at The Icahn School of Medicine at Mount Sinai, discusses the current polycythemia vera treatment paradigm.

Patients under the age of 60 or who have not experienced a prior thrombotic event are typically treated with phlebotomy with the goal of maintaining hematocrit at a level of less than 45%, Hoffman explains.

Conversely, patients over the age of 60 or who have had a prior thrombotic event usually receive myelosuppressive therapy, such as pegylated interferon or hydroxyurea, which is the current standard of care. If patients progress on those agents, they will be given the JAK1/2 inhibitor ruxolitinib (Jakafi). Additionally, it is not uncommon for patients to receive aspirin, Hoffman adds.

All these therapeutic strategies are geared toward reducing the incidence of thrombosis. However, the most important metric is sustaining hematocrit at a level of less than 45%, Hoffman says. Notably, none of the available treatment options prevent disease progression to myelofibrosis or acute myeloid leukemia (AML), Hoffman concludes.