PV Guidelines Question 1
Transcript
The correct answer is therapeutic phlebotomy to maintain hematocrit less than 45% plus low-dose aspirin when not contraindicated. Current first-line management of polycythemia vera is built on thrombosis prevention for all patients. All patients with PV should receive therapeutic phlebotomy to maintain hematocrit less than 45% and low-dose aspirin unless contraindicated. The universal foundation of initial treatment is phlebotomy plus low-dose aspirin, while hydroxyurea or interferon formulations are introduced based on risk status and clinical features.
References
- Tremblay D, Kremyanskaya M, Mascarenhas J, Hoffman R. Diagnosis and treatment of polycythemia vera: a review. JAMA. 2025;333(2):153-160. doi:10.1001/jama.2024.20377
- Benevolo G, Vassallo F, Urbino I, Giai V. Polycythemia vera (PV): update on emerging treatment options. Ther Clin Risk Manag. 2021;17:209-221. doi:10.2147/TCRM.S213020
- Referenced with permission from the NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines®) for Myeloproliferative Neoplasms V.1.2026. © National Comprehensive Cancer Network, Inc. 2026. All rights reserved. Accessed March 10, 2026. To view the most recent and complete version of the guideline, go online to NCCN.org. NCCN makes no warranties of any kind whatsoever regarding their content, use or application and disclaims any responsibility for their application or use in any way.
- Barbui T, Vannucchi AM, De Stefano V, et al. Ropeginterferon versus standard therapy for low-risk patients with polycythemia vera. NEJM Evid. 2023;2(6):EVIDoa2200335. doi:10.1056/EVIDoa2200335
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Dr Michael Grunwald is board-certified in internal medicine, hematology, and medical oncology, specializing in the treatment of hematologic malignancies. His clinical focus includes acute and chronic leukemias, myelodysplastic syndromes, and myeloproliferative neoplasms, as well as transplantation and cellular therapy. Dr Grunwald is actively involved in clinical trials focused on leukemia and allogeneic stem cell transplantation. He serves as chief of the Leukemia Section at Atrium Health Levine Cancer, Charlotte, NC, where he is also director of the Transplantation and Cellular Therapy Program. He is a professor of cancer medicine at Wake Forest University School of Medicine.
