Current Evidence and Clinical Algorithms for Targeted Management of Polycythemia Vera: Applying Trial Insights to Patient Care

Summary of Polycythemia Vera Management Algorithm

Low-Risk Polycythemia Vera (PV) Management

• Universal measures for all PV patients:
  • Low-dose aspirin (baby aspirin) daily for thromboembolic prophylaxis
  • Phlebotomy to maintain hematocrit <45%
• Monitoring requirements:
  • New thrombosis or bleeding events
  • Development of indications for cytoreductive therapy
• Indications to escalate to cytoreductive therapy:
  • New thrombotic event
  • Disease-related bleeding
  • Progressive symptoms
  • Progressive splenomegaly
  • Frequent phlebotomies (≥4 per year)

High-Risk PV Management

• Definition of high-risk:
  • Aged >60 years, OR
  • Prior history of thromboembolic event, OR
  • Both factors
• Treatment approach:
  • Daily low-dose aspirin
  • Mandatory cytoreductive therapy
  • Target hematocrit <45%

Cytoreductive Therapy Options

• First-line options:
  • Hydroxyurea
  • Pegylated interferon alfa-2a
  • Ropeginterferon alfa-2b
• Second-line options:
  • Ruxolitinib (FDA-approved for second-line use)
  • Alternative cytoreductive agent not used in first line
• Indications for switching cytoreductive therapy:
  • Loss of response
  • Continued need for phlebotomies despite high-dose therapy
  • Intolerance to current agent

This treatment algorithm emphasizes the primary treatment goal of thrombosis prevention through hematocrit control and platelet inhibition, with risk-adapted cytoreductive therapy selection for high-risk patients and those with disease complications.