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How do you assess your patients with PV?

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I think it's very important to individualize approach to care to patients whether it's PV or any other disease when it comes to patients who have PV, there are a lot of disease-defining subtleties that have to be looked into—you know, spleen size, degree of cytopenias, degree of symptoms. Is the patient able to do what they used to do five years ago? Is the level of physical activity declining?

You have to spend some time with the patient trying to understand the kind of symptoms that may be PV-related and how can we help them overcome that. Has the patient lost weight? Has the patient developed symptoms related to pain in their left upper quadrant? Do they have night sweats? Do they have bone pain? So that all is very important in assessing disease burden and the type of symptoms the patient has.

Furthermore, you need to also identify response to treatment and I do think that unlike many other tumors, PV is a disease whereby response assessment has fallen short. When you talk to people about assessing response to cancer therapy, lung cancer for example, everybody knows what to look for and they know exactly when to do the CT scans, etc. But when it comes to PV, ask physicians, "What is it that you're looking for?" I think most would probably be able to tell you by the hematocrit but many other parameters may not necessarily be well recognized.

When people start treatment, I think the physician has to decide what risk are they dealing with in this instance, and before you embark on treatment you have to decide if your patient is low- risk or high-risk for clotting essentially, and there are certain rules that we follow. So if someone is over the age of sixty or they've had a prior clot then that automatically makes them high-risk for developing clots.

I think it's important when you start somebody on a treatment to kind of understand what is it that you are trying to accomplish with this treatment and what are some of the endpoints of responses that you are looking for. So anytime I'm starting somebody with PV on a therapy, I'd like to understand the blood counts—what are they at baseline, what is it that I'm trying to accomplish basically, and of course if the patient doesn't meet certain milestone, if you will, at a certain point and time, then you start to tackle the reasons behind that.

Image of Jamile M Shammo, MD, FASCP, FACP
Jamile M Shammo, MD, FASCP, FACP Associate Professor Rush University Medical Center | Chicago, IL
As principal investigator of clinical trials in her area of expertise, Dr Shammo is heavily involved in education, research, and administrative activities in the Division of Hematology/Oncology. She is recognized nationally for her expertise in bone marrow failure syndromes/paroxysmal nocturnal hemoglobinuria (PNH) and was chosen to serve as a national coordinator for the US PNH registry.