Dr. Snyder on Mainstays of Treatment in Polycythemia Vera

David S. Snyder, MD, associate chair and professor, Department of Hematology and Hematopoietic Cell Transplantation, and hematologist/oncologist, City of Hope, discusses mainstays of treatment in polycythemia vera (PV).

There have not been many updates to the treatment paradigm of PV in recent years, says Snyder. Low-dose aspirin and phlebotomy have been the mainstays of treatment for a while. There are robust data that illustrate the importance of using low-dose aspirin and recommending phlebotomy to maintain hematocrit below 45% for men and 42% for women.

For high-risk patients who are in need of additional cytoreductive therapy, hydroxyurea has been the gold standard, adds Snyder. Interferon can also be considered for select patients—especially pegylated interferon, which is better tolerated. Another formulation called ropeginterferon alfa-2b (PEG-Intron) has also been shown to be of benefit. The therapy is longer-acting than prior formulations, but it is not yet approved for use in the United States. However, a randomized clinical trial comparing ropeginterferon with hydroxyurea has shown an advantage in the agent’s ability to reduce of JAK burden, enabling symptom control.