Myeloproliferative Neoplasms - Episode 4

Monitoring Patients With ET and PV

Jamile Shammo, MD, FACP, FASCP, tells how she would monitor ET and PV based on her personal experience.

Ruben Mesa, MD: Jamile, as we think about trying to monitor these patients with earlier disease, ET [essential thrombocythemia] and PV [polycythemia vera], they’re on cytoreduction. Maybe it’s a ET patient with Hydrea [hydroxyurea]. Maybe it’s a patient with PV on ropeginterferon. What do we really track? How do you monitor them? What does success look like? What does failure look like that you have to change?

Jamile Shammo, MD, FACP, FASCP: It’s important to monitor people who are on active treatment to make sure they’re reaching the milestones you’re trying to achieve—that is, controlling the blood counts, making sure they’re tolerating the treatment, controlling the spleen size, and especially making sure they’re not developing new bleeding or thrombotic events. Often these things are forgotten because we don’t necessarily see people who fail in that regard. They may end up at the cardiologist’s office. But these are extremely important in this patient population.

Those diseases, because they’re chronic, have this added dilemma of us trying to be cognizant that they’re going to be progressing albeit at a variant pace. Always keep an eye out for new splenomegaly, perhaps for leukocytosis or thrombocytosis or counts that aren’t necessarily optimized. Do we need to change treatment at some point? Are they progressing to myelofibrosis at some point? Looking at the peripheral smear every so often, making sure cytopenias aren’t necessarily drug related—these are things that may not be related to the disease.

I find that a very early sign of patients PV transitioning to MF [myelofibrosis] is them needing less and less treatment. You start to pull back on the treatment, and the hemoglobin gets better. But at some point, they’ll become anemic. Or you get really good at making sure you’re taking the time to see those patients. We need to be very cognizant of all the potential signs of progression, however subtle, so we can say a treatment is either working or not and then consider alternative treatments.

This transcript has been edited for clarity.