European LeukemiaNet recommendations for cytoreduction for polycythemia vera (PV) patients under 60 have just been updated and now published in The Lancet Haematology.

The expert panel of European LeukemiaNet (ELN) investigators recommends that “patients with polycythaemia vera who are younger than 60 years and have not had previous thrombotic events should start cytoreductive drug therapy if at least one of the following criteria are fulfilled:

• strictly defined intolerance to phlebotomy,
• symptomatic progressive splenomegaly,
• persistent leukocytosis (>15×10⁹ white blood cells per L),
• progressive leukocytosis (at least 100% increase if baseline count is <10×10⁹ cells per L or at least 50% increase if baseline count is >10×10⁹ cells per L),
• extreme thrombocytosis (>1500×10⁹ platelets per L),
• inadequate haematocrit control requiring phlebotomies,
• persistently high cardiovascular risk, and
• persistently high symptom burden.

Recombinant interferon alfa, either in the form of ropeginterferon alfa-2b or pegylated interferon alfa-2a, is the recommended cytoreductive treatment for these patients. The expert panel suggested that either interferon alfa or ruxolitinib should be considered for patients who are being treated with hydroxyurea but require a therapy change.”

Please note that while ropeginterferon alfa-2b is not available in Australia, pegylated interferon alfa-2a (Pegasys) is equally recommended and is available on the PBS.

The abstract from the Lancet with references is available HERE.