Hydroxyurea Use in Patients With PV Requires Active Monitoring, Management

A prospective analysis shows that active management is needed for patients with polycythemia vera (PV) given hydroxyurea to maintain blood count control, with extra monitoring for signs and symptoms of hydroxyurea intolerance (Clin Lymphoma Myeloma Leuk. 2020;20[4]:219-225).

“Polycythemia vera (PV) is associated with increased blood cell counts, risk of thrombosis, and symptoms including fatigue and pruritus. National guidelines support the use of hydroxyurea…in high-risk patients or those with some other clinical indication for cytoreduction,” explained Michael R. Grunwald, MD, Department of Hematologic Oncology and Blood Disorders, Levine Cancer Institute, Atrium Health, Charlotte, North Carolina, and colleagues.

Seeking to evaluate hydroxyurea treatment patterns and outcomes in patients with PV, Dr Grunwald et al collected data pertaining to demographics, disease burden, clinical management, patient-reported outcomes, and healthcare resource utilization for the months before enrollment and until discontinuation, death, or data cutoff for 1381 patients.

These patients had been given hydroxyurea for ≥3 months, with a median hydroxyurea exposure time frame of 23.6 months. The maximum daily hydroxyurea doses most frequently administered were 1000 mg (30.6%) and 500 mg (30.1%), and only 6.4% of patients received ≥2 g/d hydroxyurea.

Approximately 30%, 24%, and 20% of patients had dose adjustments, dose interruptions, and discontinuation of hydroxyurea, with the most common reasons for hydroxyurea cessations and interruptions being adverse events/intolerance (37.1% and 54.5%, respectively) and lack of efficacy (35.5% and 22.1%, respectively).

Among recipients of hydroxyurea for ≥3 months, approximately 60% of patients had hematocrit values > 45% on ≥1 occasion; 30% continued to receive phlebotomies; and 27% had uncontrolled myeloproliferation.

“The results of this analysis emphasize the need for active management of patients with PV with appropriate [hydroxyurea] dose titration to maintain blood count control while monitoring for signs and symptoms of [hydroxyurea] intolerance,” Dr Grunwald and colleagues concluded.—Hina Porcelli