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Busulphan is safe and efficient treatment in elderly patients with essential thrombocythemia

Leukemia volume 21, pages 2071–2072 (2007)Cite this article

The main complication in essential thrombocythemia (ET) is thrombosis induced by increased number of functional abnormal platelets.1 Cytoreductive treatment decreases the platelet count as well the incidence of vaso-occlusive events in ET patients at high risk for thrombosis. It is accepted that treatment with alkylating agents, radioactive phosphorus (32P) and, probably, antimetabolite hydroxyurea (Hu) increases the risk of leukemic transformation in ET.2 For this reason alkylating agents, such as busulphan, are not even mentioned as a therapeutic possibility in recent reviews regarding ET and are hardly used. We have attempted previously to ‘rehabilitate’ busulphan in ET treatment and showed its efficacy and lack of significant side effects when the drug was used as a single myelosuppressive agent and administered in a short 3 months schedule.3 We herein summarize the long-term outcome of 36 elderly patients with ET, who were treated with busulphan and evaluated the risk of thrombotic complications and blastic transformation in this group of patients.

We studied 36 ET patients above 60 years of age, who were treated with busulphan since December 1981. There were 13 men and 23 women; their median age at treatment was 73 years (range 60–91). The diagnosis of ET was established according to Polycythemia Vera (PV) Study Group Criteria.4 In addition to the old age, major risk factors for thrombosis such as platelet count >1500 × 109/l or history of thrombosis were found in 16 (44%) patients. Twelve patients (33%) experienced at least one thrombotic event, and 21 others suffered from circulatory disturbances (such as dizziness, headache, syncope, angina pectoris, erythromelalgia or leg ulcers) before the busulphan therapy. The median platelet count at start of busulphan was 994 × 109/l (range 783–1768).

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Authors and Affiliations

  1. The School of Medicine, Hematology Institute, Kaplan Medical Center, Hebrew University-Hadassah, Rehovot, Jerusalem, Israel

    L Shvidel, E Sigler, M Haran, A Klepfish, A Duek, A Berrebi & M Shtalrid

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  1. L Shvidel
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  2. E Sigler
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  3. M Haran
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  4. A Klepfish
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  5. A Duek
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  6. A Berrebi
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  7. M Shtalrid
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Correspondence to A Berrebi.

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Shvidel, L., Sigler, E., Haran, M. et al. Busulphan is safe and efficient treatment in elderly patients with essential thrombocythemia. Leukemia 21, 2071–2072 (2007). https://doi.org/10.1038/sj.leu.2404743

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