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Chronic myeloproliferative neoplasms

Questions arising on phlebotomy in polycythemia vera: prophylactic measures to reduce thromboembolic events require patient-focused decisions

Leukemia volume 32, pages 2085–2087 (2018)Cite this article

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More than 1500 years ago, Scribonius Largus published the maxime ‘primum non nocere, secundum cavere, tertium sanare’ to focus his Roman colleagues on the central aspect of therapeutic measures: the patient’s health and well-being. It implicates that therapeutic measures (and their side effects) need to be balanced in regard to expected benefits and outcome. Treatment of myeloproliferative neoplasia has been focused on cytoreduction for a long time, as pathophysiological aspects (e.g., identification of the underlying driver mutation) had not been clarified and targeted therapies had not been developed or approved. Following discovery of molecular targets within the last decade and the emergence of Janus-kinase (JAK) inhibitors, which can ameliorate and even abrogate constitutional and inflammatory symptoms [1], quality of life has come into focus as a therapeutic goal [2]. Physical activity, productivity and well-being of patients suffering from polycythemia vera (PV) are severely hampered by the disease and improvement of quality of life as well as reduction of symptom burden have become a major therapeutic goal for both PV patients and their physicians [3,4,5]. Therefore, therapeutic goals for patients diagnosed with PV clearly need to be re-defined. Among a variety of measures, physicians as well as patients have clarified clinical needs that should be taken into consideration:

  1. (i)

    Risk reduction in regard to thromboembolic events

  2. (ii)

    Symptom control and improvement of quality of life

  3. (iii)

    Delay/reduction of malignant transformation and progression to myelofibrosis [5, 6]

Risk reduction in regard to thromboembolic events

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Authors and Affiliations

  1. Klinik für Innere Medizin II, Hämatologie und Onkologie, Universitätsklinikum Jena, Jena, Germany

    Florian H. Heidel & Andreas Hochhaus

  2. Krukenberg Krebszentrum Halle, Universitätsklinikum Halle, Halle (Saale), Germany

    Haifa-Kathrin Al-Ali

  3. Klinik und Poliklinik für Innere Medizin C, Universitätsklinikum Greifswald, Greifswald, Germany

    Carsten Hirt

  4. Praxis für Hämatologie und Onkologie, Lüdenscheid, Germany

    Dietrich Kämpfe

  5. Gemeinschaftspraxis für Hämatologie und Onkologie, Magdeburg, Germany

    Kathleen Jentsch-Ullrich

  6. Medizinische Klinik III, Universitätsmedizin Rostock, Rostock, Germany

    Christian Junghanss

  7. Klinik für Hämatologie und Onkologie, Palliativmedizin Klinikum Bad Hersfeld, Bad Hersfeld, Germany

    Ralf Nowak

  8. Praxis für Hämatologie und Onkologie, Leipzig, Germany

    Andreas Schwarzer

  9. Hämatologisch-onkologische Gemeinschaftspraxis Halle, Halle, Germany

    Claudia Spohn

  10. Abteilung Hämatologie, Onkologie und Hämostaseologie, Universitätsklinikum Leipzig, Leipzig, Germany

    Vladan Vucinic

  11. Klinik für Hämatologie und Onkologie, Asklepios Klinikum Weissenfels, Weissenfels, Germany

    Thoralf Lange

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  1. Florian H. Heidel
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For the Working Party Myeloproliferative Neoplasms of the East German Study Group Hematology/Oncology (OSHO)

Corresponding author

Correspondence to Andreas Hochhaus.

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Conflict of interest

FHH has served as an advisory board member for Novartis Inc., AH received research support from Novartis, BMS, Incyte and Pfizer. The other authors declare that they have no conflict of interest.

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Heidel, F.H., Al-Ali, HK., Hirt, C. et al. Questions arising on phlebotomy in polycythemia vera: prophylactic measures to reduce thromboembolic events require patient-focused decisions. Leukemia 32, 2085–2087 (2018). https://doi.org/10.1038/s41375-018-0214-x

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