From ASH Meeting on Hematologic Malignancies: Treating “Problematic” Cases of Polycythemia Vera

Ruben A. Mesa, MD
Director, UT Health San Antonio MD Anderson Cancer Center

During their presentations, MHM speakers will be asking the audience how they would respond to patient cases. Audience members will vote live at the meeting via an audience response system, but we want to know what you would do.


A 60-year-old man has had JAK2V617F-mutated polycythemia vera for four years and is on phlebotomy and aspirin. He has not experienced any thrombotic events. He has a palpable spleen and his MPN 10 (a tool for tracking symptoms of myeloproliferative neoplasms) score is 40 out of 100. He also experiences frequent migraines that improve after phlebotomy.

His lab results are as follows:

  • Hemoglobin 15.8 g/dL (hematocrit [HCT] 49%)
  • White blood cells 14×109/L
  • Platelets 670×109/L

According to clinical guidelines from the National Comprehensive Cancer Network and European Society of Medical Oncology, which of the following would not be appropriate firstline management for high-risk polycythemia vera?

  1. Phlebotomy (HCT<45%), aspirin, and hydroxyurea
  2. Phlebotomy (HCT <45%), aspirin, and pegylated interferon
  3. Phlebotomy (HCT <45%), aspirin, and ruxolitinib
  4. Phlebotomy (HCT <45%), aspirin

Let us know how you would respond at!

Here’s how audience members responded:

  • Phlebotomoy, aspirin, and hydroxyurea
  • Phlebotomy, aspirin, and pegylated interferon
  • Phlebotomy, aspirin, and ruxolitinib
  • Phlebotomy and aspirin

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