RESPONSE Trial and Hydroxyurea Resistance
Dr. Kuykendall comments on the high rates of hematocrit control and spleen response with ruxolitinib vs standard therapy in the RESPONSE trial for hydroxyurea-resistant/intolerant PV, and how these efficacy findings inform his treatment choices.
Case: Management of Advanced Polycythemia Vera in a 67-Year-Old-Male
Clinical Presentation:
- 67-year-old male presented with frequent headache and dizziness
- Prior medical history is notable for smoking.
- PMH: unremarkable, no splenomegaly
Initial Clinical Workup and Diagnosis:
- Labs:
- Hemoglobin, 20.5 g/dL
- White blood cell count, 13 K/L
- Platelet count, 380 K/L
- Hematocrit, 68%
- JAK2-V617F mutation- variant allele frequency of 65%
- Bone marrow biopsy: trilineage proliferation and pleiomorphic megakaryocytes
- The patient started phlebotomy, aspirin, and Hydroxyurea (HU)
Initial Treatments:
- The patient started phlebotomy, aspirin and HU.
- Over the next year the patient underwent several phlebotomies and remained on aspirin and 2000 mg/day of HU
Disease Progression and Subsequent Treatments:
February 2019
- 2 phlebotomies since the last visit 3 months earlier
- He is also experiencing fatigue and night sweats.
- Labs
- Hgb, 15.5 g/dL
- WBC, 13 K/L
- Platelet count, 380 K/L
- Hematocrit, 47%
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