A real-world study of predictors of response to hydroxyurea and switch to ruxolitinib in patients with polycythemia vera

[hunter5582]

From our friends at MPN Hub. A very Interesting and easy to understand review of a recent article. Some excerpts are copied below. It is worth reading the whole article to understand the findings.

mpn-hub.com/medical-informa...

Currently, hydroxyurea (HU) is the most used cytoreductive therapy, but it is associated with poor responses and toxicity in a significant proportion of patients. Moreover, the predictors of a complete response (CR) with HU and its prognostic implications are yet to be defined.1 The impact of different types of suboptimal responses in patients switching to ruxolitinib (RUX) is also unclear.1 ....

Clinical outcomes based on response to HU

Among the 449 patients receiving only HU, 51 thrombotic events, 25 hemorrhagic events, and 43 infections were recorded.

52 patients developed a secondary primary malignancy, 14 patients progressed to post-PV myelofibrosis, 10 progressed to blast phase, and death was reported in 35 patients.

Achieving a response defined by European LeukemiaNet with HU was not associated with a reduced risk of thrombosis (p = 0.86), decreased risk of disease progression (p = 0.9), or reduced risk of death (p = 0.86).

However, prior thrombotic events were associated with subsequent thrombotic events (p = 0.01).

An age of ≥65 years was associated with an increased mortality risk (p = 0.02).

Conclusion

This real-world, retrospective cohort study highlights the importance of optimizing HU dosing. Although higher HU dosing achieves greater rates of CR it also increases the risk of TRAEs. In addition, the study also demonstrates the lack of an association between CR and reduced thrombotic risk. Therefore, HU dosing should be determined based on individual patient needs. Furthermore, a large proportion of stable poor responders continued HU treatment, emphasizing the need to improve overall therapeutic strategy. ....

The referenced article - a bit more difficult to read

mdpi.com/2072-6694/15/14/3706

[dbus1417]

HU to me seems like such a crude one size fits all instrument for managing these conditions, but I get that they are complex diseases. I am hopeful that many of the prospective therapies in development pan out. It seems like several are promising and tailored to the various mutations.

[JAB6 in reply to dbus1417]

Totally agree these new options will be approved sooner than later. It is my belief that many therapies used now will be deemed antiquated with little long term value in treating MPNs. Hopefully the US are working closely with global scientists to improve medications that don’t severely affect patients quality of life.

[socrates_8]

Nice summary Steve...

Saw this one in MPN-Hub and a few other quite interesting articles to. It's an excellent resource...

Thanks for Steve

Steve

(Sydney)