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Chronic myeloproliferative neoplasms

Evidence- and consensus-based recommendations for phlebotomy in polycythemia vera

Leukemia volume 32, pages 2077–2081 (2018)Cite this article

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Phlebotomy is central to the management of polycythemia vera (PV) [1]. However, there are no formal recommendations how phlebotomy should be done, what is the best target hematocrit, how to deal with adverse events, or standard definitions of intolerance and/or resistance to phlebotomy. Lack of appropriate guidelines on these issues may be associated with sub-optimal care or even harm.

The Italian Society of Hematology (SIE), in cooperation with two Italian Societies of Blood Transfusion (SIMTI and SIDEM), convened a panel of experts for developing recommendations regarding phlebotomy in persons with PV. Publications reporting efficacy of phlebotomy-related procedures in persons with PV with a comparison group were critically appraised to rate confidence in estimates of effect size for each outcome using GRADE methodology [2]. To address key questions, we used a three-round Delphi process and two consensus conferences held in Bologna, Italy, in 2017.

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Acknowledgements

The authors are responsible for the views expressed and they do not represent the views, decisions or policies of the institutions with which they are affiliated. A.M.V., F.P. and G.B. were supported by a grant from Associazione Italiana per la Ricerca sul Cancro (AIRC; Milan, Italy), Special Program Molecular Clinical Oncology 5 × 1000 to AIRC-Gruppo Italiano Malattie Mieloproliferative (AGIMM) project #1005. Funding of the project was provided by SIE society and an unrestricted grant from Novartis (Italy) provided to SIE. The funding source had no role in identifying statements, abstracting data, synthesizing results preparing the typescript or the decision to submit the typescript for publication.

Author contribution

G.B., S.T., and T.B. conceived and designed the study. G.B. developed the search strategy and data extraction and interpretation. G.B. prepared the text of the critical appraisal of evidence for the randomized controlled trials cited. T.B., F.P., P.A., F.P., A.M.V., C.V., S.T., and G.B. wrote the first draft and participated to the consensus meetings. G.B. prepared the typescript. R.P.G. provided advices on the layout of the manuscript. All authors approved the final version.

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Authors and Affiliations

  1. Clinical Research Foundation (FROM), Ospedale Papa Giovanni XXIII, Bergamo, Italy

    Tiziano Barbui

  2. Department of Medicine and Surgery, University of Insubria, ASST Sette Laghi - Ospedale di Circolo, Varese, Italy

    Francesco Passamonti

  3. Department of Hematology, Transfusion Medicine and Biotechnologies, Ospedale Civile, Pescara, Italy

    Patrizia Accorsi

  4. Dipartimento di Medicina Clinica e Chirurgia. Università di Napoli Federico II, Napoli, Italy

    Fabrizio Pane

  5. Center for Research and Innovation of Myeloproliferative Neoplasms, AOU Careggi, and Laboratorio Congiunto, University of Florence, Florence, Italy

    Alessandro M. Vannucchi

  6. Italian Society of Tranfusion Medicine and Immunohematology (SIMTI), Roma, Italy

    Claudio Velati

  7. Department of Medicine, Haematology Research Centre, Division of Experimental Medicine, Imperial College London, London, UK

    Robert P. Gale

  8. University of Bologna, Bologna, Italy

    Sante Tura

  9. Center for the Study of Myelofibrosis, IRCCS Policlinico S. Matteo Foundation, Pavia, Italy

    Giovanni Barosi

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  1. Tiziano Barbui
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  8. Sante Tura
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Corresponding author

Correspondence to Giovanni Barosi.

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Conflict of interest

T.B. received advisory board funds from Novartis. F.P. received advisory board funds from Novartis, Roche and Janssen and speaker bureau funds from Novartis, Sandoz, Janssen, and Celgene. P.A. received a research grant from Sanofi. F.P. received speaker bureau funds from Novartis. A.M.V. received a funds from Novartis for an advisory board and for research. R.P.G. is a part-time employee of Celgene Corp. G.B. received advisory board funds from Novartis.The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

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Barbui, T., Passamonti, F., Accorsi, P. et al. Evidence- and consensus-based recommendations for phlebotomy in polycythemia vera. Leukemia 32, 2077–2081 (2018). https://doi.org/10.1038/s41375-018-0199-5

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