Increased Thrombotic Risk in Essential Thrombocythemia

Srdan Verstovsek, MD, PhD, a professor of Medicine and a hematologic oncologist at the University of Texas MD Anderson Cancer Center, discusses the increased thrombotic risk and management for patients with essential thrombocythemia (ET).

Patients who are at high-risk of developing blood clotting are those older than the age of 60 and those who have a JAK2 mutation. Additionally, those who have a history of blood clotting are at an increased thrombotic risk.

Verstovsek notes that a current standard practice for these patients is to prescribe hydroxyurea to decrease the blood cell count and anagrelide (Agrylin) in the second-line.

Transcription:

0:08 | In essential thrombocythemia or ET, we worry about the thrombotic risk and our priority is to decrease it. We define the patients that are at an increased risk of blood clotting by applying certain prognostic factors. A significant change in the prognostication happened several years ago, which is now incorporated in United States based guidance, the NCCN guidelines. This is to say that in addition to historical factors of age over 60, or history of blood clotting, now, we also account for a presence or absence of a JAK2 mutation, which is present in about 60% of ET patients and it drives the disease process.

0:50 | Therefore, there is a significant shift in identifying those that are at high risk of blood clotting by adding a JAK2 mutation presence to age. So patients that are older than 60 and have a JAK2 mutation are the high-risk patients or of course, those that have a history of blood clotting. There is also an attempt to improve our management of these patients. Standard practice is to prescribe hydroxyurea, which is chemotherapy by mouth, to decrease the blood cell count. Then anagrelide is a second-line agent which inhibits the growth of the cells in the bone marrow that make platelets, so it lowers the platelets.