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Dr Verstovsek on assessing the dynamic clinical characteristics of PV

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The goals of therapy in polycythemia vera are beyond just controlling the red blood cell count. The goal is to control the red blood cell count, white blood cell count, spleen, platelets, and symptoms. And follow a trend for a possible change. It is not the disease is always static. It does change over time. If there is a trend for a change, we may be talking about advanced polycythemia vera where we lose control of these factors.

It is very important in every practice to pay attention when we treat polycythemia vera patients not only on a control of the red blood cell count in aiming for hematocrit below 45%, but also to look at the increased white blood cell count. This is now more or less a standard practice and it’s building our guidance how to manage polycythemia vera patients because there is a very large evidence from multiple reports that leukocytosis is a risk factor for thrombosis. White blood cell count in particular is a good target for therapy even in the cases where the red blood cell count is controlled well. Because of [notion] and now data showing that increase in white blood cell count is independent risk factor for thrombosis.

Polycythemia vera has two aspects to it. One is the proliferation of the blood cell count. But the other aspect is inflammation that comes with polycythemia vera that can affect the wellbeing of the patients. After all, this is a myeloproliferative neoplasm that affects red blood cells, white cells, and platelets to equal extent, and is myeloproliferative but also inflammatory condition that leads to increased risk of thrombosis, but also to poor quality of life. Polycythemia vera related symptoms are something that we should be assessing in our everyday management of polycythemia vera patients. I’m talking about itching, night sweating, low-grade fever, abdominal fullness. Many times, the quality of life or presence of polycythemia vera symptoms is actually tied to uncontrolled proliferation. If you have increase in white cell count, you are required too many phlebotomies to decrease the red blood cell count – that is usually manifested in bad quality of life or polycythemia vera-related symptoms.

head shot of Dr Verstovsek
Srdan Verstovsek, MD, PhD Professor MD Anderson Cancer Center | Houston, TX
Dr Verstovsek’s clinical and translational research focuses on the biological analysis and development of new therapies for patients with myeloproliferative neoplasms (MPNs), and he has served as principal investigator in more than 50 clinical trials. He has published over 400 peer-reviewed manuscripts, actively participates in several national patient organizations, and frequently speaks at engagements at MPN-related events across the globe.