Clinical Summary: 

• Design/Population: This retrospective chart review evaluated phlebotomy utilization, treatment burden, tolerability, and iron deficiency among patients with polycythemia vera treated in community, academic, and mixed practice settings.
• Key Outcomes: Phlebotomy remained widely used despite available cytoreductive therapies, with frequent treatment interruptions, discontinuations, and evidence of poor response or tolerability in a substantial proportion of patients.
• Clinical Relevance: These findings highlight ongoing challenges with phlebotomy-based management and underscore the need for more effective therapies that reduce reliance on phlebotomy while maintaining hematocrit control.

Results from a retrospective real-world analysis demonstrated that phlebotomy remains widely used in the management of polycythemia vera, despite substantial treatment burden and challenges achieving durable hematocrit control.

“Guideline‑aligned [polycythemia vera] management targets hematocrit <45% using [phlebotomy]  and/or cytoreductive therapy, whereas [phlebotomy] is often used as first-line treatment,” stated Naveen Pemmaraju, MD, MD Anderson Cancer Center, Houston, Texas, and coauthors. “Given implementation and [phlebotomy] burden may vary by clinical setting, this study assessed [phlebotomy] utilization, interruptions/discontinuations, tolerability, and iron deficiency, overall and by practice setting.

In this study, investigators reviewed de-identified records from 128 adults with polycythemia vera diagnosed between August 2020 and July 2023 who had at least 24 months of follow-up. Patients were treated in community (n = 60), academic (n = 50), or mixed (n = 18) practice settings. Outcomes included phlebotomy utilization, interruptions and discontinuations, tolerability, and phlebotomy-related iron deficiency.

At analysis, 71% received phlebotomy either alone or in combination with cytoreductive therapy. The most common planned phlebotomy schedule was every 4 weeks, and 79% of patients had a target hematocrit below 45%. During periods without cytoreductive therapy, patients underwent a mean of 7.3 phlebotomies per patient-year.

Phlebotomy interruptions were reported in 18% of treated patients, most commonly because of hematologic factors. Overall, 34% of patients discontinued phlebotomy, with hematologic reasons accounting for 41% of discontinuations. Poor phlebotomy response or tolerability was reported in 29% of phlebotomy-treated patients. Among these patients, the mean duration of phlebotomy before discontinuation was 294 days. Following discontinuation because of poor response or tolerability, half of patients initiated cytoreductive therapy, including hydroxyurea, ruxolitinib, or ropeginterferon alfa-2b, while the remaining half had no subsequent treatment documented.

Phlebotomy-related iron deficiency was reported in 17% of patients. Fatigue was reported in 93% of patients during their first episode of iron deficiency. Management strategies included pausing phlebotomy in 60% of patients and administering iron supplementation in 40%.

“These findings highlight a need for more effective, better‑tolerated treatments that reduce [phlebotomy] reliance, achieve and maintain [hematocrit] control and support consistent care across settings,” concluded Dr Pemmaraju et al. 

Source: 

Naveen Pemmaraju N, Fan A, Cerretani A, et al. Real-world phlebotomy (PHL) burden and treatment gaps in US patients with polycythemia vera: A chart review across physician practice settings. Presented at the 2026 ASCO Annual Meeting. Chicago, Illinois. Abstract e18588.