Expert Insights

What are some common misconceptions of disease burden and risk in PV?

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One of the common misconceptions in community setting related to PV management is that this is disease only of the red blood cell count and it’s not. Patients come to the clinic every three or four months for example, have automatic CBC done, and this is kind of autopilot setting to assess the thrombotic risk based on red blood cell count. Now, polycythemia vera is much more than just increase in the red blood cell count. It comes with increased white cell count, increased platelets, progressive increase in spleen, and a number of symptoms related to polycythemia vera, so symptom burden may be significant.

In polycythemia vera, the goals of therapy should be control the risk of thrombosis. This is achieved primarily by looking at the red blood cell count and instituting phlebotomy or cytoreductive therapy as necessary. But behind that, at this time and age, we also look at increase in white blood cell count, increase in platelets, progressive increase in the spleen, or control of the PV related systemic symptoms. Therefore, we have five factors that we should assess every time we see a polycythemia vera patient. After all, we are talking about the person. So one needs to control the blood cell count, spleen, and symptoms that are related to PV. If that is not achievable, that is the sign of advanced polycythemia vera.

Management of PV patients usually is tied to control of a thrombotic risk. We know how to identify patients at a high risk for thrombosis within the PV pool of patients and act appropriately to decrease that risk. But the assessment of a quality of life, a symptom burden for example, is one of the factors in management of polycythemia vera patients that we often do not talk about. So thrombotic risk is one factor, the symptom burden is another factor, and they may be tied to each other. The assessment of the person in every practice that has polycythemia vera therefore needs to extend beyond looking at the blood cell count, looking at the physical exam, progressive splenomegaly, and a key here for assessment of the symptoms is asking proper questions that may be PV-related.

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.