MPN Quiz #5

A 59-year-old man presents with a history of rheumatoid arthritis and a 3-year history of PV. He was initially treated with aspirin and phlebotomy. He was started on hydroxyurea (HU) 2 g/d 1 year ago after experiencing a thrombotic event. He had continued phlebotomies on a quarterly basis. He presents to the office today complaining of pruritus, insomnia, and abdominal pain which showed an enlarged spleen on palpitation. CBC revealed Hct 50% and a high score on a MPN symptom tool (MPN-10).

Which of the following would you recommend as next step treatment of his PV?

Continue current cytoreductive therapy and do a phlebotomy

Phlebotomize and switch to ruxolitinib for cytoreductive therapy

Switch to PEG-interferon for cytoreductive therapy

All of the following are European Leukemia Net (ELN) criteria for hydroxyurea (HU) resistance or intolerance except:

Need for phlebotomy to achieve Hct <45% after receiving ≥2 g/d HU for ≥3 months

Failure to reduce splenomegaly by ≥40% after receiving ≥2 g/d HU for ≥3 months

Platelets <100 x 10[9]/L

Failure to completely relieve symptoms related to splenomegaly after receiving ≥2 g/d HU for ≥3 months

What is the current goal for hematocrit control in hopes of reducing incidence of major thrombosis and cardiovascular events?

<48%

<40%

<50%

<45%

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MPN Quiz #5