PV Management Question 3
Transcript
The correct answer is that persistent leukocytosis may suggest an inadequately controlled disease and should be considered alongside symptoms, splenomegaly, and overall symptom burden. We have learned that persistent leukocytosis should not be dismissed based on control of hematocrit that is currently suggested as a target of less than 45%. And then in patients that would otherwise have control or uncontrolled symptoms, splenomegaly, and overall symptoms burden, we still pay significant attention to persistent leukocytosis that has been shown to play a significant role for disease control. Actually, the European LeukemiaNET guidelines currently identify persistent or progressive leukocytosis to be a feature of disease that is uncontrolled and should be considered for initiating of cytoreductive therapy, despite patients having otherwise controlled hematocrit, or barely controlled, or slightly progressive symptoms, splenomegaly, or other measured symptom burden that we can use.
References
- Marchetti M, Vannucchi AM, Griesshammer M, et al. Appropriate management of polycythaemia vera with cytoreductive drug therapy: European LeukemiaNet 2021 recommendations. Lancet Haematol. 2022;9(4):e301-e311. doi:10.1016/S2352-3026(22)00046-1
- ELN 2021 guideline recommendations for polycythemia vera. MPN Hub. May 10, 2022. Accessed April 15, 2026. https://mpn-hub.com/medical-information/eln-2021-guideline-recommendations-for-polycythemia-vera
- Gerds AT, Mesa R, Burke JM, et al. Association between elevated white blood cell counts and thrombotic events in polycythemia vera: analysis from REVEAL. Blood. 2024;143(16):1646-1655. doi:10.1182/blood.2023020232
- Grunwald MR, Burke JM, Kuter DJ, et al. Symptom burden and blood counts in patients with polycythemia vera in the United States: an analysis from the REVEAL study. Clin Lymphoma Myeloma Leuk. 2019;19(9):579-584.e1. doi:10.1016/j.clml.2019.06.001
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Dr Masarova is an associate professor in the Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, TX. She is also co-leader of Myeloproliferative Neoplasms Session, Division of Cancer Medicine, at MD Anderson. Dr Masarova earned her medical degree from Comenius University Bratislava School of Medicine, Bratislava, Slovakia, and completed research and clinical fellowships in Leukemia at UT MD Anderson. While in Slovakia, Dr Masarova actively collaborated with researchers from other European sites to co-develop the largest Central European database of invasive fungal infections. She is a highly motivated physician, pursuing an academic, translational-research career while expanding her broad knowledge, training, and expertise in oncology and hematology. Her research includes various aspects of hematologic malignancies, with special interest in infections, immune system involvement, and influence of disease background and therapies on their outcome. Dr Masarova has completed many research projects and first-authored several manuscripts in peer-reviewed journals in addition to presenting her research at large Hematologic and Oncologic Conferences worldwide.
