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Chronic myeloproliferative neoplasms

Response to “Questions arising on phlebotomy in polycythemia vera: prophylactic measures to reduce thromboembolic events require patient-focused decisions” by Heidel et al.

Leukemia volume 32, pages 2727–2728 (2018)Cite this article

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Heidel and co-workers [1] question our recommendation to use intensive phlebotomy in persons with PV needing hematocrit control [2]. They claim early use of cytoreductive drugs may prevent severe iron deficiency that may be associated with poor quality of life. We, in contrast, considered iron deficiency an objective of therapeutic phlebotomy that usefully replaces the need of chemotherapy, unless symptoms of severe tissue iron deficiency appear.

Why these discordant recommendations? We produced our recommendation by a consensus technique because there are no high-quality clinical data. Our recommendation is based on results of a planned, structured discussion amongst experts. Accordingly, deciding whether to prefer the potential development of severe iron deficiency from phlebotomy versus early use of drugs was based on a critical appraisal of several additional variables, including anticipated desired and undesired effects, costs, and feasibility of therapy options [3, 4].

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References

  1. Heidel FH, Al-Ali H-K, Hirt C, Kampfe D, Jentsch-Ullrich K, Junghanss C, et al. Questions arising on phlebotomy in polycythemia vera: prophylactic measures to reduce thromboembolic events require patient-focused decisions. Leukemia 2018. [Epub ahead of print]

  2. Barbui T, Passamonti F, Accorsi P, Pane F, Vannucchi AM, Velati C, et al. Evidence- and consensus-based recommendations for phlebotomy in polycythemia vera. Leukemia. 2018. [Epub ahead of print]

  3. Alonso-Coello P, Schünemann HJ, Moberg J, Brignardello-Petersen R, Akl EA, Davoli M, et al. GRADE Evidence to Decision (EtD) frameworks: a systematic and transparent approach to making well informed healthcare choices. 1: Introduction. BMJ. 2016;353:i2016.

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  4. Alonso-Coello P, Oxman AD, Moberg J, Brignardello-Petersen R, Akl EA, Davoli M, et al. GRADE Evidence to Decision (EtD) frameworks: a systematic and transparent approach to making well informed healthcare choices. 2: Clinical practice guidelines. BMJ. 2016;353:i2089.

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  5. Barosi G, Gale RP Is there expert consensus on expert consensus? Bone Marrow Transplant 2018. [Epub ahead of print]

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Authors and Affiliations

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

    Giovanni Barosi

  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 Peter Gale

  8. University of Bologna, Bologna, Italy

    Sante Tura

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

    Tiziano Barbui

Authors
  1. Giovanni Barosi
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  2. Francesco Passamonti
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  3. Patrizia Accorsi
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  4. Fabrizio Pane
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  5. Alessandro M. Vannucchi
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  6. Claudio Velati
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  7. Robert Peter Gale
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  8. Sante Tura
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  9. Tiziano Barbui
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Corresponding author

Correspondence to Giovanni Barosi.

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Conflict of interest

GB received advisory board funds from Novartis. FP received advisory board funds from Novartis, Roche and Janssen and speaker bureau funds from Novartis, Sandoz, Janssen and Celgene. PA received a research grant from Sanofi. FP received speaker bureau funds from Novartis. AMV received a fund from Novartis for an advisory board and for research. RPG is a part-time employee of Celgene Corp. TB 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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Barosi, G., Passamonti, F., Accorsi, P. et al. Response to “Questions arising on phlebotomy in polycythemia vera: prophylactic measures to reduce thromboembolic events require patient-focused decisions” by Heidel et al.. Leukemia 32, 2727–2728 (2018). https://doi.org/10.1038/s41375-018-0259-x

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  • DOI: https://doi.org/10.1038/s41375-018-0259-x

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