Hydroxyurea and Anagrelide

[mbr8076]

Goid evening,

I visited a local hematologist this week, not my MPN specialist, due to non coverage and he suggested trying combo of Hydroxyurea and Anagrelide. Has anyone used this combination for treatment of ET? Also, maybe (2) 81 mg baby aspirin/ day to counteract the ever increasing platelets which at present are 650 while taking 500 mg Hydroxyurea 4 days a week and 1000 mg 3 days /week.

May I ask if high LDH means anything; is it a side affect of Hysroxyurea or sign of progression?

Thank you for any replies,

Mbr8076

[hunter5582]

Here is a bit of information

LDH is also called lactic acid dehydrogenase. It is an enzyme. An enzyme is a protein that speeds up certain chemical reactions in your body. LDH helps your cells make energy. It is found in almost all the tissues in your body. The largest amounts of LDH are found in your muscles, liver, kidneys, and red blood cells.

If disease or injury damages tissues that have LDH, their cells release the enzyme into your bloodstream or other body fluids. It's normal to have some LDH in your blood and body fluids. But if your LDH levels are high, it may be a sign of certain diseases or injuries. medlineplus.gov/lab-tests/l...

LDH is monitored in MPNs since it is considered a risk factor. How this may apply to you is something to discuss with a MPN specialist who knows your case. As far as I know, it is not a HU adverse effect.

Regarding combining HU and anagrelide, there are some on the forum who have done this but it is not common. Anagrelide can have significant side effects which is why it is considered a second-line treatment option. Pegasys is the other first-line treatment option for ET. it is sometimes used together with HU, but caution is needed as combining cytoreductive agents can cause too much myelosuppression.

I would suggest not making any decisions without talking to your MPN Specialist. Discuss what you treatment goals should be, noting that there is no particular value to PLT<450 for many people with ET. Some docs use PLT<600 when a number is used at all. There is a risk/benefit calculation that needs to be made regarding cytoreduction. I would also be sure to discuss all of your treatment options, including Pegasys and clinical trials.

Wishing you all the best.

[Cja1956]

I have been on both of those drugs but never together. That seems like overkill to me. They each have their own side effects. Anagrelide caused heart palpitations and hydroxyurea increased my fatigue and brain fog. If you take both, how will you know which drug is causing which symptom? I agree with Hunter that a Mpn specialist would have more knowledge regarding the correct medication.

As far as LDH, my original Hematologist never checked it. When I switched to an Mpn specialist in 2019 it was in the 400s. As my MF has progressed it has now risen to around 1200. The simple explanation is that it indicates tissue damage somewhere in the body.

[monarch5000]

Have you heard about the drug Pegasys interferon? It can be started before platelets reach one million and has disease progression slowing or stopping benefits beyond hydroxyurea and anagrelide. It also routinely lowers moderately elevated LDH to normal. Here is some recent information about interferon for ET and PV your doctor may not be aware of: ash.confex.com/ash/2023/web...

Excerpt: "importantly our data demonstrate that interferon specifically compared to other cytoreductive agents yields significantly better myelofibrosis free survival compared to other treatments. These results support the use of interferon as a currently available disease-modifying agent to improve long-term myelofibrosis free survival and also warrant reconsideration of earlier treatment in patients with ET and PV with interferon to improve myelofibrosis free survival potentially as a primary aim."

[ETket]

I have been on a combination of Hydroxycarbamide and Anagrelide for a couple of years now as the Hydroxycarbamide was getting less effective at reducing my platelets. The side effects of both are more unpleasant than my ET symptoms of which I am fortunate enough to have few. The Anagrelide gives me heart palpitations twice a day, an hour or two after taking them.

[Daeminee]

Have been using Anagralide with baby aspirin for more than 15 years now. I tolerate it better than Hydroxyurea with I only took for 3 years.