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What are some of the goals that drive clinical decision-making for PV?

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The principal goal of therapy in patients with PV is to reduce the risk of thrombotic events. That is the number one problem that we encounter with patients with PV. Patients are divided into two risk groups: those who are at high risk of a thrombotic event, and those who are a low risk but still have a risk of a thrombotic event. Patients who are over the age of sixty, or who have ever had a thrombotic event, are at high risk of a thrombotic event, and patients under the age of sixty and who have never had a thrombotic event are at lower risk of having a thrombotic event.

Thrombotic events in these patients can occur in the form of heart attacks, strokes, and clots in abdominal blood vessels, which are very uncommon.

First and foremost, we always worry about the hematocrit and optimizing that to lower the risk of thrombosis. Beyond that, however, I think it’s very important that we take into account a patient’s symptom burden. Now patients can have variable symptoms when they have PV. Some patients have little to no symptoms, but some patients have very important symptoms that are debilitating. I think it’s important to recognize those symptoms as an important treatment landmark.

A patient’s risk of thrombosis doesn’t necessarily correlate with their symptom burden, and so those two goals are sometimes divergent. We have to be cognizant of that when treating a patient.

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Raajit K Rampal, MD, PhD Hematologic Oncologist Memorial Sloan Kettering Cancer Center | New York, NY
Dr Rampal is a hematology-oncology physician specializing in the treatment of myeloproliferative neoplasms (MPNs) and leukemia. As an active researcher, Dr Rampal is working to understand the genetic events that contribute to the development and progression of MPNs/leukemia and is focused on the development of new and innovative approaches to the treatment of these diseases.