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Erschienen in: Current Hematologic Malignancy Reports 5/2022

06.08.2022 | Myeloproliferative Neoplasms (P Bose, Section Editor)

Advances in Risk Stratification and Treatment of Polycythemia Vera and Essential Thrombocythemia

verfasst von: Ivan Krecak, Marko Lucijanic, Srdan Verstovsek

Erschienen in: Current Hematologic Malignancy Reports | Ausgabe 5/2022

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Abstract

Purpose of Review

Estimating and modifying thrombotic risk is currently the mainstay of care for patients with polycythemia vera (PV) and essential thrombocythemia (ET). In recent years, however, increased attention has shifted towards quality of life and disease modification. In this review, we discuss recent advances in risk stratification, present updated results for ruxolitinib and interferon randomized clinical trials, discuss new approaches in antiplatelet and anticoagulant treatment, and summarize early phase trials of novel agents and emerging therapeutic concepts for the treatment of PV and ET.

Recent Findings

International collaborations and novel technologies, i.e., next-generation sequencing and machine learning techniques, have demonstrated excellent abilities to improve thrombotic risk stratification in PV and ET. Updated results from ruxolitinib and interferon randomized clinical trials have confirmed excellent efficacy and safety of these agents, both as first- and second-line treatments. Early trials of novel agents (histone deacetylase inhibitors, telomerase inhibitors, lysine-specific demethylase-1 inhibitors, human double-minute 2 inhibitors, and hepcidin mimetics) have shown encouraging efficacy and safety in blood count control, reduction of splenomegaly, and alleviation of disease-related symptoms. Finally, accumulating evidence suggested that direct oral anticoagulants may be a valid therapeutic alternative to warfarin for prolonged thromboprophylaxis.

Summary

International collaborations (“big data”) with the help of new technologies represent an exciting new approach to analyze rare outcomes in rare diseases, especially for identifying novel prognostic biomarkers in PV and ET. Randomized clinical trials are also needed to fully elucidate whether novel agents may establish new standards of care.
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Zurück zum Zitat Zhou D, Chen W, Cheng H, Qiao JL, Zhu LL, Li ZY, et al. Clinico-hematological profile and thrombotic/hemorrhagic events in 150 Chinese patients with essential thrombocythemia. Leuk Res. 2018;69:1–6.PubMedCrossRef Zhou D, Chen W, Cheng H, Qiao JL, Zhu LL, Li ZY, et al. Clinico-hematological profile and thrombotic/hemorrhagic events in 150 Chinese patients with essential thrombocythemia. Leuk Res. 2018;69:1–6.PubMedCrossRef
44.
Zurück zum Zitat Lucijanic M, Cicic D, Stoos-Veic T, Pejsa V, Lucijanic J, Fazlic Dzankic A, et al. Elevated neutrophil-to-lymphocyte-ratio and platelet-to-lymphocyte ratio in myelofibrosis: inflammatory biomarkers or representatives of myeloproliferation itself? Anticancer Res. 2018;38(5):3157–63.PubMed Lucijanic M, Cicic D, Stoos-Veic T, Pejsa V, Lucijanic J, Fazlic Dzankic A, et al. Elevated neutrophil-to-lymphocyte-ratio and platelet-to-lymphocyte ratio in myelofibrosis: inflammatory biomarkers or representatives of myeloproliferation itself? Anticancer Res. 2018;38(5):3157–63.PubMed
45.
Zurück zum Zitat Tefferi A, Loscocco GG, Farrukh F, Szuber N, Mannelli F, Pardanani AD, et al. A globally applicable “triple AAA” risk model for essential thrombocythemia based on age, absolute neutrophil count, and absolute lymphocyte count. Blood. 2021;138(Supplement_1):238.CrossRef Tefferi A, Loscocco GG, Farrukh F, Szuber N, Mannelli F, Pardanani AD, et al. A globally applicable “triple AAA” risk model for essential thrombocythemia based on age, absolute neutrophil count, and absolute lymphocyte count. Blood. 2021;138(Supplement_1):238.CrossRef
46.
Zurück zum Zitat Vannucchi AM, Pieri L, Guglielmelli P. JAK2 allele burden in the myeloproliferative neoplasms: effects on phenotype, prognosis and change with treatment. Ther Adv Hematol. 2011;2(1):21–32.PubMedPubMedCentralCrossRef Vannucchi AM, Pieri L, Guglielmelli P. JAK2 allele burden in the myeloproliferative neoplasms: effects on phenotype, prognosis and change with treatment. Ther Adv Hematol. 2011;2(1):21–32.PubMedPubMedCentralCrossRef
47.
Zurück zum Zitat Pasca S, Chifotides HT, Verstovsek S, Bose P. Mutational landscape of blast phase myeloproliferative neoplasms (BP-MPN) and antecedent MPN. In: Cellular and molecular aspects of MPNs - part B, Volume 366, Bartalucci N, Ed., In International Review of Cell and Molecular Biology, Bartalucci N, Galuzzi L, Serial Eds., Academic Press. 1st edition. 2022, pp. 83–124 Pasca S, Chifotides HT, Verstovsek S, Bose P. Mutational landscape of blast phase myeloproliferative neoplasms (BP-MPN) and antecedent MPN. In: Cellular and molecular aspects of MPNs - part B, Volume 366, Bartalucci N, Ed., In International Review of Cell and Molecular Biology, Bartalucci N, Galuzzi L, Serial Eds., Academic Press. 1st edition. 2022, pp. 83–124
48.
Zurück zum Zitat •• Tefferi A, Guglielmelli P, Lasho TL, Coltro G, Finke CM, Loscocco GG, et al. Mutation-enhanced international prognostic systems for essential thrombocythaemia and polycythaemia vera. Br J Haematol. 2020;189(2):291–302. This international, multicenter retrospective study has identified novel molecular biomarkers which may help to identify patients under an increased risk of inferior outcomes and additionally proposed a novel, molecularly based, prognostic model in PV and ET.PubMedCrossRef •• Tefferi A, Guglielmelli P, Lasho TL, Coltro G, Finke CM, Loscocco GG, et al. Mutation-enhanced international prognostic systems for essential thrombocythaemia and polycythaemia vera. Br J Haematol. 2020;189(2):291–302. This international, multicenter retrospective study has identified novel molecular biomarkers which may help to identify patients under an increased risk of inferior outcomes and additionally proposed a novel, molecularly based, prognostic model in PV and ET.PubMedCrossRef
49.
Zurück zum Zitat Guglielmelli P, Gangat N, Coltro G, Lasho TL, Loscocco GG, Finke CM, et al. Mutations and thrombosis in essential thrombocythemia. Blood Cancer J. 2021;11(4):77.PubMedPubMedCentralCrossRef Guglielmelli P, Gangat N, Coltro G, Lasho TL, Loscocco GG, Finke CM, et al. Mutations and thrombosis in essential thrombocythemia. Blood Cancer J. 2021;11(4):77.PubMedPubMedCentralCrossRef
50.
Zurück zum Zitat • Alvarez-Larrán A, Díaz-González A, Such E, Mora E, Andrade-Campos M, García-Hernández C, MPN Spanish Group (GEMFIN), et al. Genomic characterization of patients with polycythemia vera developing resistance to hydroxyurea. Leukemia. 2021;35(2):623–7. This study was to first to analyze molecular profiles of patients with PV, before and at the time of hydroxyurea resistance, identifying potentially high-risk mutations for developing hydroxyurea resistance.PubMedCrossRef • Alvarez-Larrán A, Díaz-González A, Such E, Mora E, Andrade-Campos M, García-Hernández C, MPN Spanish Group (GEMFIN), et al. Genomic characterization of patients with polycythemia vera developing resistance to hydroxyurea. Leukemia. 2021;35(2):623–7. This study was to first to analyze molecular profiles of patients with PV, before and at the time of hydroxyurea resistance, identifying potentially high-risk mutations for developing hydroxyurea resistance.PubMedCrossRef
51.
Zurück zum Zitat Knudsen TA, Skov V, Stevenson K, Werner L, Duke W, Laurore C, et al. Genomic profiling of a randomized trial of interferon-α vs hydroxyurea in MPN reveals mutation-specific responses. Blood Adv. 2022;6(7):2107–19.PubMedPubMedCentralCrossRef Knudsen TA, Skov V, Stevenson K, Werner L, Duke W, Laurore C, et al. Genomic profiling of a randomized trial of interferon-α vs hydroxyurea in MPN reveals mutation-specific responses. Blood Adv. 2022;6(7):2107–19.PubMedPubMedCentralCrossRef
52.
Zurück zum Zitat Quintás-Cardama A, Abdel-Wahab O, Manshouri T, Kilpivaara O, Cortes J, Roupie AL, et al. Molecular analysis of patients with polycythemia vera or essential thrombocythemia receiving pegylated interferon α-2a. Blood. 2013;122(6):893–901.PubMedPubMedCentralCrossRef Quintás-Cardama A, Abdel-Wahab O, Manshouri T, Kilpivaara O, Cortes J, Roupie AL, et al. Molecular analysis of patients with polycythemia vera or essential thrombocythemia receiving pegylated interferon α-2a. Blood. 2013;122(6):893–901.PubMedPubMedCentralCrossRef
53.
Zurück zum Zitat Marchioli R, Finazzi G, Specchia G, Cacciola R, Cavazzina R, Cilloni D, et al. Cardiovascular events and intensity of treatment in polycythemia vera. N Engl J Med. 2013;368:22–33.PubMedCrossRef Marchioli R, Finazzi G, Specchia G, Cacciola R, Cavazzina R, Cilloni D, et al. Cardiovascular events and intensity of treatment in polycythemia vera. N Engl J Med. 2013;368:22–33.PubMedCrossRef
54.
Zurück zum Zitat Landolfi R, Marchioli R, Kutti J, Gisslinger H, Tognoni G, Patrono C, European Collaboration on Low-Dose Aspirin in Polycythemia Vera Investigators, et al. Efficacy and safety of low-dose aspirin in polycythemia vera. N Engl J Med. 2004;350(2):114–24.PubMedCrossRef Landolfi R, Marchioli R, Kutti J, Gisslinger H, Tognoni G, Patrono C, European Collaboration on Low-Dose Aspirin in Polycythemia Vera Investigators, et al. Efficacy and safety of low-dose aspirin in polycythemia vera. N Engl J Med. 2004;350(2):114–24.PubMedCrossRef
55.
Zurück zum Zitat Michiels JJ, Berneman Z, Schroyens W, Koudstaal PJ, Lindemans J, Neumann HA, et al. Platelet-mediated erythromelalgic, cerebral, ocular and coronary microvascular ischemic and thrombotic manifestations in patients with essential thrombocythemia and polycythemia vera: a distinct aspirin-responsive and coumadin-resistant arterial thrombophilia. Platelets. 2006;17(8):528–44.PubMedCrossRef Michiels JJ, Berneman Z, Schroyens W, Koudstaal PJ, Lindemans J, Neumann HA, et al. Platelet-mediated erythromelalgic, cerebral, ocular and coronary microvascular ischemic and thrombotic manifestations in patients with essential thrombocythemia and polycythemia vera: a distinct aspirin-responsive and coumadin-resistant arterial thrombophilia. Platelets. 2006;17(8):528–44.PubMedCrossRef
56.
Zurück zum Zitat Alvarez-Larrán A, Pereira A, Arellano-Rodrigo E, Hernández-Boluda JC, Cervantes F, Besses C. Cytoreduction plus low-dose aspirin versus cytoreduction alone as primary prophylaxis of thrombosis in patients with high-risk essential thrombocythaemia: an observational study. Br J Haematol. 2013;161(6):865–71.PubMedCrossRef Alvarez-Larrán A, Pereira A, Arellano-Rodrigo E, Hernández-Boluda JC, Cervantes F, Besses C. Cytoreduction plus low-dose aspirin versus cytoreduction alone as primary prophylaxis of thrombosis in patients with high-risk essential thrombocythaemia: an observational study. Br J Haematol. 2013;161(6):865–71.PubMedCrossRef
57.
Zurück zum Zitat • Alvarez-Larrán A, Pereira A, Guglielmelli P, Hernández-Boluda JC, Arellano-Rodrigo E, Ferrer-Marín F, et al. Antiplatelet therapy versus observation in low-risk essential thrombocythemia with a CALR mutation. Haematologica. 2016;101(8):926–31. This observational retrospective study has shown that CALR-mutated low-risk patients with ET may not benefit from aspirin.PubMedPubMedCentralCrossRef • Alvarez-Larrán A, Pereira A, Guglielmelli P, Hernández-Boluda JC, Arellano-Rodrigo E, Ferrer-Marín F, et al. Antiplatelet therapy versus observation in low-risk essential thrombocythemia with a CALR mutation. Haematologica. 2016;101(8):926–31. This observational retrospective study has shown that CALR-mutated low-risk patients with ET may not benefit from aspirin.PubMedPubMedCentralCrossRef
58.
Zurück zum Zitat •• Rocca B, Tosetto A, Betti S, Soldati D, Petrucci G, Rossi E, et al. A randomized double-blind trial of 3 aspirin regimens to optimize antiplatelet therapy in essential thrombocythemia. Blood. 2020;136(2):171–82. This study was the first to show that twice-daily aspirin regimen in patients with ET may have the optimal safety and efficacy when compared to once-daily and thrice-daily regimens.PubMedCrossRef •• Rocca B, Tosetto A, Betti S, Soldati D, Petrucci G, Rossi E, et al. A randomized double-blind trial of 3 aspirin regimens to optimize antiplatelet therapy in essential thrombocythemia. Blood. 2020;136(2):171–82. This study was the first to show that twice-daily aspirin regimen in patients with ET may have the optimal safety and efficacy when compared to once-daily and thrice-daily regimens.PubMedCrossRef
59.
Zurück zum Zitat Tosetto A, Rocca B, Petrucci G, Betti S, Soldati D, Rossi E, Aspirin Regimens in EsSentialthrombocythemia (ARES) Investigators, et al. Association of platelet thromboxane inhibition by low-dose aspirin with platelet count and cytoreductive therapy in essential thrombocythemia. Clin Pharmacol Ther. 2022;111(4):939–49.PubMedCrossRef Tosetto A, Rocca B, Petrucci G, Betti S, Soldati D, Rossi E, Aspirin Regimens in EsSentialthrombocythemia (ARES) Investigators, et al. Association of platelet thromboxane inhibition by low-dose aspirin with platelet count and cytoreductive therapy in essential thrombocythemia. Clin Pharmacol Ther. 2022;111(4):939–49.PubMedCrossRef
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Zurück zum Zitat De Stefano V, Ruggeri M, Cervantes F, Alvarez-Larrán A, Iurlo A, Randi ML, et al. High rate of recurrent venous thromboembolism in patients with myeloproliferative neoplasms and effect of prophylaxis with vitamin K antagonists. Leukemia. 2016;30:2032–8.PubMedCrossRef De Stefano V, Ruggeri M, Cervantes F, Alvarez-Larrán A, Iurlo A, Randi ML, et al. High rate of recurrent venous thromboembolism in patients with myeloproliferative neoplasms and effect of prophylaxis with vitamin K antagonists. Leukemia. 2016;30:2032–8.PubMedCrossRef
61.
Zurück zum Zitat De Stefano V, Vannucchi AM, Ruggeri M, Cervantes F, Alvarez-Larrán A, Iurlo A, et al. Splanchnic vein thrombosis in myeloproliferative neoplasms: risk factors for recurrences in a cohort of 181 patients. Blood Cancer J. 2016;6(11): e493.PubMedPubMedCentralCrossRef De Stefano V, Vannucchi AM, Ruggeri M, Cervantes F, Alvarez-Larrán A, Iurlo A, et al. Splanchnic vein thrombosis in myeloproliferative neoplasms: risk factors for recurrences in a cohort of 181 patients. Blood Cancer J. 2016;6(11): e493.PubMedPubMedCentralCrossRef
62.
Zurück zum Zitat Ianotto JC, Couturier MA, Galinat H, Mottier D, Berthou C, Guillerm G, et al. Administration of direct oral anticoagulants in patients with myeloproliferative neoplasms. Int J Hematol. 2017;106(4):517–21.PubMedCrossRef Ianotto JC, Couturier MA, Galinat H, Mottier D, Berthou C, Guillerm G, et al. Administration of direct oral anticoagulants in patients with myeloproliferative neoplasms. Int J Hematol. 2017;106(4):517–21.PubMedCrossRef
63.
Zurück zum Zitat Serrao A, Breccia M, Napolitano M, Fiori L, Santoro M, Scalzulli E, et al. A multicenter real-life study on anticoagulant treatment with direct oral anticoagulants in patients with Ph-negative myeloproliferative neoplasms. Am J Hematol. 2020 Dec;95(12):E329–32.PubMedCrossRef Serrao A, Breccia M, Napolitano M, Fiori L, Santoro M, Scalzulli E, et al. A multicenter real-life study on anticoagulant treatment with direct oral anticoagulants in patients with Ph-negative myeloproliferative neoplasms. Am J Hematol. 2020 Dec;95(12):E329–32.PubMedCrossRef
64.
Zurück zum Zitat •• Barbui T, De Stefano V, Carobbio A, Iurlo A, Alvarez-Larran A, Cuevas B, et al. Direct oral anticoagulants for myeloproliferative neoplasms: results from an international study on 442 patients. Leukemia. 2021;35(10):2989–93. This is the largest international retrospective multicenter study to show that direct oral anticoagulants may be a safe alternative to warfarin in patients with PV and ET.PubMedPubMedCentralCrossRef •• Barbui T, De Stefano V, Carobbio A, Iurlo A, Alvarez-Larran A, Cuevas B, et al. Direct oral anticoagulants for myeloproliferative neoplasms: results from an international study on 442 patients. Leukemia. 2021;35(10):2989–93. This is the largest international retrospective multicenter study to show that direct oral anticoagulants may be a safe alternative to warfarin in patients with PV and ET.PubMedPubMedCentralCrossRef
65.
Zurück zum Zitat Hamulyák EN, Daams JG, Leebeek FWG, Biemond BJ, Te Boekhorst PAW, Middeldorp S, et al. A systematic review of antithrombotic treatment of venous thromboembolism in patients with myeloproliferative neoplasms. Blood Adv. 2021;5(1):113–21.PubMedPubMedCentralCrossRef Hamulyák EN, Daams JG, Leebeek FWG, Biemond BJ, Te Boekhorst PAW, Middeldorp S, et al. A systematic review of antithrombotic treatment of venous thromboembolism in patients with myeloproliferative neoplasms. Blood Adv. 2021;5(1):113–21.PubMedPubMedCentralCrossRef
66.
Zurück zum Zitat Cortelazzo S, Finazzi G, Ruggeri M, Vestri O, Galli M, Rodeghiero F, et al. Hydroxyurea for patients with essential thrombocythemia and a high-risk of thrombosis. N Engl J Med. 1995;332:1132–6.PubMedCrossRef Cortelazzo S, Finazzi G, Ruggeri M, Vestri O, Galli M, Rodeghiero F, et al. Hydroxyurea for patients with essential thrombocythemia and a high-risk of thrombosis. N Engl J Med. 1995;332:1132–6.PubMedCrossRef
67.
Zurück zum Zitat • Godfrey AL, Campbell PJ, MacLean C, Buck G, Cook J, Temple J, United Kingdom Medical Research Council Primary Thrombocythemia-1 Study; United Kingdom National Cancer Research Institute Myeloproliferative Neoplasms Subgroup; French Intergroup of Myeloproliferative Neoplasms; the Australasian Leukaemia and Lymphoma Group, et al. Hydroxycarbamide plus aspirin versus aspirin alone in patients with essential thrombocythemia age 40 to 59 years without high-risk features. J Clin Oncol. 2018;36(34):3361–9. This randomized clinical trial demonstrated no benefit from adding cytoreduction to ET patients aged 40–59 years without high-risk features.PubMedPubMedCentralCrossRef • Godfrey AL, Campbell PJ, MacLean C, Buck G, Cook J, Temple J, United Kingdom Medical Research Council Primary Thrombocythemia-1 Study; United Kingdom National Cancer Research Institute Myeloproliferative Neoplasms Subgroup; French Intergroup of Myeloproliferative Neoplasms; the Australasian Leukaemia and Lymphoma Group, et al. Hydroxycarbamide plus aspirin versus aspirin alone in patients with essential thrombocythemia age 40 to 59 years without high-risk features. J Clin Oncol. 2018;36(34):3361–9. This randomized clinical trial demonstrated no benefit from adding cytoreduction to ET patients aged 40–59 years without high-risk features.PubMedPubMedCentralCrossRef
68.
Zurück zum Zitat Harrison CN, Campbell PJ, Buck G, Wheatley K, East CL, Bareford D, United Kingdom Medical Research Council Primary Thrombocythemia 1 Study, et al. Hydroxyurea compared with anagrelide in high-risk essential thrombocythemia. N Engl J Med. 2005;353(1):33–45.PubMedCrossRef Harrison CN, Campbell PJ, Buck G, Wheatley K, East CL, Bareford D, United Kingdom Medical Research Council Primary Thrombocythemia 1 Study, et al. Hydroxyurea compared with anagrelide in high-risk essential thrombocythemia. N Engl J Med. 2005;353(1):33–45.PubMedCrossRef
69.
Zurück zum Zitat Gisslinger H, Gotic M, Holowiecki J, Penka M, Thiele J, Kvasnicka HM, ANAHYDRET Study Group, et al. Anagrelide compared with hydroxyurea in WHO-classified essential thrombocythemia: the ANAHYDRET study, a randomized controlled trial. Blood. 2013;121(10):1720–8.PubMedPubMedCentralCrossRef Gisslinger H, Gotic M, Holowiecki J, Penka M, Thiele J, Kvasnicka HM, ANAHYDRET Study Group, et al. Anagrelide compared with hydroxyurea in WHO-classified essential thrombocythemia: the ANAHYDRET study, a randomized controlled trial. Blood. 2013;121(10):1720–8.PubMedPubMedCentralCrossRef
70.
Zurück zum Zitat • Barbui T, Vannucchi AM, Finazzi G, Finazzi MC, Masciulli A, Carobbio A, et al. reappraisal of the benefit-risk profile of hydroxyurea in polycythemia vera: a propensity-matched study. Am J Hematol. 2017;92(11):1131–6. This study is a propensity-matched analysis of the ECLAP clinical trials that further reinforced the use of hydroxyurea in high-risk patients with PV.PubMedCrossRef • Barbui T, Vannucchi AM, Finazzi G, Finazzi MC, Masciulli A, Carobbio A, et al. reappraisal of the benefit-risk profile of hydroxyurea in polycythemia vera: a propensity-matched study. Am J Hematol. 2017;92(11):1131–6. This study is a propensity-matched analysis of the ECLAP clinical trials that further reinforced the use of hydroxyurea in high-risk patients with PV.PubMedCrossRef
71.
Zurück zum Zitat • Grunwald MR, Kuter DJ, Altomare I, Burke JM, Gerds AT, Walshauser MA, et al. Treatment patterns and blood counts in patients with polycythemia vera treated with hydroxyurea in the United States: an analysis from the REVEAL study. Clin Lymphoma Myeloma Leuk. 2020;20(4):219–25. This observational real-life study from the USA evaluated treatment patterns in PV patients treated with hydroxyurea and demonstrated that a significant proportion of patients has uncontrolled myeloproliferation and disease-related symptoms despite cytoreduction.PubMedCrossRef • Grunwald MR, Kuter DJ, Altomare I, Burke JM, Gerds AT, Walshauser MA, et al. Treatment patterns and blood counts in patients with polycythemia vera treated with hydroxyurea in the United States: an analysis from the REVEAL study. Clin Lymphoma Myeloma Leuk. 2020;20(4):219–25. This observational real-life study from the USA evaluated treatment patterns in PV patients treated with hydroxyurea and demonstrated that a significant proportion of patients has uncontrolled myeloproliferation and disease-related symptoms despite cytoreduction.PubMedCrossRef
72.
Zurück zum Zitat Alvarez-Larrán A, Kerguelen A, Hernández-Boluda JC, Pérez-Encinas M, Ferrer-Marín F, Bárez A, et al. Frequency and prognostic value of resistance/intolerance to hydroxycarbamide in 890 patients with polycythaemia vera. Br J Haematol. 2016;172(5):786–93.PubMedCrossRef Alvarez-Larrán A, Kerguelen A, Hernández-Boluda JC, Pérez-Encinas M, Ferrer-Marín F, Bárez A, et al. Frequency and prognostic value of resistance/intolerance to hydroxycarbamide in 890 patients with polycythaemia vera. Br J Haematol. 2016;172(5):786–93.PubMedCrossRef
73.
Zurück zum Zitat Barosi G, Birgegard G, Finazzi G, Griesshammer M, Harrison C, Hasselbalch H, et al. A unified definition of clinical resistance and intolerance to hydroxycarbamide in polycythaemia vera and primary myelofibrosis: results of a European LeukemiaNet (ELN) consensus process. Br J Haematol. 2010;148(6):961–3. PubMedCrossRef Barosi G, Birgegard G, Finazzi G, Griesshammer M, Harrison C, Hasselbalch H, et al. A unified definition of clinical resistance and intolerance to hydroxycarbamide in polycythaemia vera and primary myelofibrosis: results of a European LeukemiaNet (ELN) consensus process. Br J Haematol. 2010;148(6):961–3. PubMedCrossRef
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Zurück zum Zitat Raman I, Pasricha SR, Prince HM, Yannakou CK. Management of hydroxyurea resistant or intolerant polycythemia vera. Leuk Lymphoma. 2021;62(10):2310–9.PubMedCrossRef Raman I, Pasricha SR, Prince HM, Yannakou CK. Management of hydroxyurea resistant or intolerant polycythemia vera. Leuk Lymphoma. 2021;62(10):2310–9.PubMedCrossRef
75.
Zurück zum Zitat Kiladjian JJ, Cassinat B, Chevret S, Turlure P, Cambier N, Roussel M, et al. Pegylated interferon-alfa-2a induces complete hematologic and molecular responses with low toxicity in polycythemia vera. Blood. 2008;112(8):3065–72.PubMedCrossRef Kiladjian JJ, Cassinat B, Chevret S, Turlure P, Cambier N, Roussel M, et al. Pegylated interferon-alfa-2a induces complete hematologic and molecular responses with low toxicity in polycythemia vera. Blood. 2008;112(8):3065–72.PubMedCrossRef
76.
Zurück zum Zitat Quintas-Cardama A, Kantarjian H, Manshouri T, Luthra R, Estrov Z, Pierce S, et al. Pegylated interferon alfa-2a yields high rates of hematologic and molecular response in patients with advanced essential thrombocythemia and polycythemia vera. J Clin Oncol. 2009;27(32):5418–24.PubMedPubMedCentralCrossRef Quintas-Cardama A, Kantarjian H, Manshouri T, Luthra R, Estrov Z, Pierce S, et al. Pegylated interferon alfa-2a yields high rates of hematologic and molecular response in patients with advanced essential thrombocythemia and polycythemia vera. J Clin Oncol. 2009;27(32):5418–24.PubMedPubMedCentralCrossRef
77.
Zurück zum Zitat Masarova L, Patel KP, Newberry KJ, Cortes J, Borthakur G, Konopleva M, et al. Pegylated interferon alfa-2a in patients with essential thrombocythaemia or polycythaemia vera: a post-hoc, median 83 month follow-up of an open-label, phase 2 trial. Lancet Haematol. 2017;4(4):e165–75.PubMedPubMedCentralCrossRef Masarova L, Patel KP, Newberry KJ, Cortes J, Borthakur G, Konopleva M, et al. Pegylated interferon alfa-2a in patients with essential thrombocythaemia or polycythaemia vera: a post-hoc, median 83 month follow-up of an open-label, phase 2 trial. Lancet Haematol. 2017;4(4):e165–75.PubMedPubMedCentralCrossRef
78.
Zurück zum Zitat Masarova L, Yin CC, Cortes JE, Konopleva M, Borthakur G, Newberry KJ, et al. Histomorphological responses after therapy with pegylated interferon α-2a in patients with essential thrombocythemia (ET) and polycythemia vera (PV). Exp Hematol Oncol. 2017;6:30.PubMedPubMedCentralCrossRef Masarova L, Yin CC, Cortes JE, Konopleva M, Borthakur G, Newberry KJ, et al. Histomorphological responses after therapy with pegylated interferon α-2a in patients with essential thrombocythemia (ET) and polycythemia vera (PV). Exp Hematol Oncol. 2017;6:30.PubMedPubMedCentralCrossRef
79.
Zurück zum Zitat • Abu-Zeinah G, Krichevsky S, Cruz T, Hoberman G, Jaber D, Savage N, et al. Interferon-alpha for treating polycythemia vera yields improved myelofibrosis-free and overall survival. Leukemia. 2021;35(9):2592–601. This large retrospective multicenter study with a long follow-up has shown that PV patients treated with interferons have improved clinical outcomes when compared to those treated with hydroxyurea or phlebotomy only.PubMedPubMedCentralCrossRef • Abu-Zeinah G, Krichevsky S, Cruz T, Hoberman G, Jaber D, Savage N, et al. Interferon-alpha for treating polycythemia vera yields improved myelofibrosis-free and overall survival. Leukemia. 2021;35(9):2592–601. This large retrospective multicenter study with a long follow-up has shown that PV patients treated with interferons have improved clinical outcomes when compared to those treated with hydroxyurea or phlebotomy only.PubMedPubMedCentralCrossRef
80.
Zurück zum Zitat Yacoub A, Mascarenhas J, Kosiorek H, Prchal JT, Berenzon D, Baer MR, et al. Pegylated interferon alfa-2a for polycythemia vera or essential thrombocythemia resistant or intolerant to hydroxyurea. Blood. 2019;134(18):1498–509.PubMedPubMedCentralCrossRef Yacoub A, Mascarenhas J, Kosiorek H, Prchal JT, Berenzon D, Baer MR, et al. Pegylated interferon alfa-2a for polycythemia vera or essential thrombocythemia resistant or intolerant to hydroxyurea. Blood. 2019;134(18):1498–509.PubMedPubMedCentralCrossRef
81.
Zurück zum Zitat De Oliveira RD, Soret-Dulphy J, Zhao LP, Marcault C, Gauthier N, Verger E, et al. Interferon-alpha (IFN) therapy discontinuation is feasible in myeloproliferative neoplasm (MPN) patients with complete hematological remission. Blood. 2020;136(Supplement 1):35–6.CrossRef De Oliveira RD, Soret-Dulphy J, Zhao LP, Marcault C, Gauthier N, Verger E, et al. Interferon-alpha (IFN) therapy discontinuation is feasible in myeloproliferative neoplasm (MPN) patients with complete hematological remission. Blood. 2020;136(Supplement 1):35–6.CrossRef
82.
Zurück zum Zitat •• Mascarenhas J, Kosiorek HE, Prchal JT, Rambaldi A, Berenzon D, Yacoub A, Harrison CN, et al. A randomized, phase 3, trial of interferon-α versus hydroxyurea in polycythemia vera and essential thrombocythemia. Blood. 2022:blood.2021012743. This randomized phase 3 trial compared interferon with hydroxyurea for first-line treatment of PV and ET. The randomized trial demonstrated that both interferon and hydroxyurea comparably control the blood cell counts, suggesting that both agents could be offered as first-line treatment. Interestingly, although interferons resulted in a greater reduction of the JAK2 allele burden, histological response was more often seen in patients treated with hydroxyurea. •• Mascarenhas J, Kosiorek HE, Prchal JT, Rambaldi A, Berenzon D, Yacoub A, Harrison CN, et al. A randomized, phase 3, trial of interferon-α versus hydroxyurea in polycythemia vera and essential thrombocythemia. Blood. 2022:blood.2021012743. This randomized phase 3 trial compared interferon with hydroxyurea for first-line treatment of PV and ET. The randomized trial demonstrated that both interferon and hydroxyurea comparably control the blood cell counts, suggesting that both agents could be offered as first-line treatment. Interestingly, although interferons resulted in a greater reduction of the JAK2 allele burden, histological response was more often seen in patients treated with hydroxyurea.
83.
Zurück zum Zitat Gisslinger H, Buxhofer-Ausch V, Thaler J, Forjan W, Willenbacher E, Wolf D, et al. Long-term efficacy and safety of ropeginterferon alfa-2b in patients with polycythemia vera — final phase I/II Peginvera study results. Blood. 2018;132(Supplement 1):3030.CrossRef Gisslinger H, Buxhofer-Ausch V, Thaler J, Forjan W, Willenbacher E, Wolf D, et al. Long-term efficacy and safety of ropeginterferon alfa-2b in patients with polycythemia vera — final phase I/II Peginvera study results. Blood. 2018;132(Supplement 1):3030.CrossRef
84.
Zurück zum Zitat •• Gisslinger GH, Klade C, Georgiev P, Krochmalczyk D, Gercheva-Kyuchukova L, Egyed M, PROUD-PV Study Group, et al. Ropeginterferon alfa-2b versus standard therapy for polycythaemia vera (PROUD-PV and CONTINUATION-PV): a randomised, non-inferiority, phase 3 trial and its extension study. Lancet Haematol. 2020;7(3):e196–208. This was a randomized study assessing ropeginterferon vs. hydroxyurea in PV patients who were either newly diagnosed or already on hydroxyurea but not optimally managed. After 1 year, non-inferiority of ropeginterferon with respect to hematological and spleen responses was not shown; however, after 24–36 months, more ropeginterferon-treated patients achieved complete hematological and molecular responses.PubMedCrossRef •• Gisslinger GH, Klade C, Georgiev P, Krochmalczyk D, Gercheva-Kyuchukova L, Egyed M, PROUD-PV Study Group, et al. Ropeginterferon alfa-2b versus standard therapy for polycythaemia vera (PROUD-PV and CONTINUATION-PV): a randomised, non-inferiority, phase 3 trial and its extension study. Lancet Haematol. 2020;7(3):e196–208. This was a randomized study assessing ropeginterferon vs. hydroxyurea in PV patients who were either newly diagnosed or already on hydroxyurea but not optimally managed. After 1 year, non-inferiority of ropeginterferon with respect to hematological and spleen responses was not shown; however, after 24–36 months, more ropeginterferon-treated patients achieved complete hematological and molecular responses.PubMedCrossRef
85.
Zurück zum Zitat • Kiladjian JJ, Klade C, Georgiev P, Krochmalczyk D, Gercheva-Kyuchukova L, Egyed M, et al. PROUD-PV Study Group. Long-term outcomes of polycythemia vera patients treated with ropeginterferon Alfa-2b. Leukemia. 2022. https://doi.org/10.1038/s41375-022-01528-x. This study reports the 5-year follow-up of the PROUD-PV trial. Ropeginterferon continued to effectively control the hematocrit, achieve durable molecular responses, and minimize the occurrence of thromboembolic events in patients with PV. • Kiladjian JJ, Klade C, Georgiev P, Krochmalczyk D, Gercheva-Kyuchukova L, Egyed M, et al. PROUD-PV Study Group. Long-term outcomes of polycythemia vera patients treated with ropeginterferon Alfa-2b. Leukemia. 2022. https://​doi.​org/​10.​1038/​s41375-022-01528-x. This study reports the 5-year follow-up of the PROUD-PV trial. Ropeginterferon continued to effectively control the hematocrit, achieve durable molecular responses, and minimize the occurrence of thromboembolic events in patients with PV.
86.
Zurück zum Zitat Gisslinger H, Klade C, Georgiev P, Krochmalczyk D, Gercheva-Kyuchukova L, Egyed M, et al. S196: ropeginterferon alfa-2B achieves patient-specific treatment goals in polycythemia vera: final results from the PROUD-PV/CONTINUATION-PV studies. HemaSphere. 2022;6:97–8.CrossRef Gisslinger H, Klade C, Georgiev P, Krochmalczyk D, Gercheva-Kyuchukova L, Egyed M, et al. S196: ropeginterferon alfa-2B achieves patient-specific treatment goals in polycythemia vera: final results from the PROUD-PV/CONTINUATION-PV studies. HemaSphere. 2022;6:97–8.CrossRef
87.
Zurück zum Zitat •• Barbui T, Vannucchi AM, De Stefano V, Masciulli A, Carobbio A, Ferrari A, et al. Ropeginterferon alfa-2b versus phlebotomy in low-risk patients with polycythaemia vera (Low-PV study): a multicentre, randomised phase 2 trial. Lancet Haematol. 2021;8(3):e175–84. The results of this randomized trial indicated that the addition of ropeginterferon to phlebotomy is more efficacious than the current standard therapy of phlebotomy alone in low-risk PV patients with respect to hematocrit control and the number of phlebotomies needed to achieve this goal. These results challenge phlebotomy-only as a standard of care in low-risk PV patients.PubMedCrossRef •• Barbui T, Vannucchi AM, De Stefano V, Masciulli A, Carobbio A, Ferrari A, et al. Ropeginterferon alfa-2b versus phlebotomy in low-risk patients with polycythaemia vera (Low-PV study): a multicentre, randomised phase 2 trial. Lancet Haematol. 2021;8(3):e175–84. The results of this randomized trial indicated that the addition of ropeginterferon to phlebotomy is more efficacious than the current standard therapy of phlebotomy alone in low-risk PV patients with respect to hematocrit control and the number of phlebotomies needed to achieve this goal. These results challenge phlebotomy-only as a standard of care in low-risk PV patients.PubMedCrossRef
88.
Zurück zum Zitat Mesa RA, Komatsu N, Gill H, Jin J, Lee S-E, Hou H-A, et al. Surpass-ET trial: a phase 3, open-label, multicenter, randomized, active-controlled study to assess pharmacokinetics and compare the efficacy, safety, and tolerability of P1101 vs anagrelide as second line therapy for essential thrombocythemia. Blood. 2021;138(Supplement 1):1491.CrossRef Mesa RA, Komatsu N, Gill H, Jin J, Lee S-E, Hou H-A, et al. Surpass-ET trial: a phase 3, open-label, multicenter, randomized, active-controlled study to assess pharmacokinetics and compare the efficacy, safety, and tolerability of P1101 vs anagrelide as second line therapy for essential thrombocythemia. Blood. 2021;138(Supplement 1):1491.CrossRef
89.
Zurück zum Zitat •• Vannucchi AM, Kiladjian JJ, Griesshammer M, Masszi T, Durrant S, Passamonti F, et al. Ruxolitinib versus standard therapy for the treatment of polycythemia vera. N Engl J Med. 2015;372(5):426–35. This randomized clinical trial placed ruxolitinib as a first-line treatment option for PV patients with splenomegaly who are resistant or intolerant to hydroxyurea because it showed superiority of ruxolitinib over standard therapy in the achievement of composite endpoint of both hematocrit control and spleen volume reduction at 32 weeks.PubMedPubMedCentralCrossRef •• Vannucchi AM, Kiladjian JJ, Griesshammer M, Masszi T, Durrant S, Passamonti F, et al. Ruxolitinib versus standard therapy for the treatment of polycythemia vera. N Engl J Med. 2015;372(5):426–35. This randomized clinical trial placed ruxolitinib as a first-line treatment option for PV patients with splenomegaly who are resistant or intolerant to hydroxyurea because it showed superiority of ruxolitinib over standard therapy in the achievement of composite endpoint of both hematocrit control and spleen volume reduction at 32 weeks.PubMedPubMedCentralCrossRef
90.
Zurück zum Zitat Kiladjian JJ, Zachee P, Hino M, Pane F, Masszi T, Harrison CN, Mesa R, et al. Long-term efficacy and safety of ruxolitinib versus best available therapy in polycythaemia vera (RESPONSE): 5-year follow up of a phase 3 study. Lancet Haematol. 2020;7(3):e226–37.PubMedPubMedCentralCrossRef Kiladjian JJ, Zachee P, Hino M, Pane F, Masszi T, Harrison CN, Mesa R, et al. Long-term efficacy and safety of ruxolitinib versus best available therapy in polycythaemia vera (RESPONSE): 5-year follow up of a phase 3 study. Lancet Haematol. 2020;7(3):e226–37.PubMedPubMedCentralCrossRef
91.
Zurück zum Zitat Verstovsek S, Harrison CN, Kiladjian JJ, Miller C, Naim AB, Paranagama DC, et al. Markers of iron deficiency in patients with polycythemia vera receiving ruxolitinib or best available therapy. Leuk Res. 2017;56:52–9.PubMedCrossRef Verstovsek S, Harrison CN, Kiladjian JJ, Miller C, Naim AB, Paranagama DC, et al. Markers of iron deficiency in patients with polycythemia vera receiving ruxolitinib or best available therapy. Leuk Res. 2017;56:52–9.PubMedCrossRef
92.
Zurück zum Zitat •• Passamonti F, Griesshammer M, Palandri F, Egyed M, Benevolo G, Devos T, et al. Ruxolitinib for the treatment of inadequately controlled polycythaemia vera without splenomegaly (RESPONSE-2): a randomised, open-label, phase 3b study. Lancet Oncol. 2017;18(1):88–99. This randomized trial was similarly designed to RESPONSE but included PV patients without splenomegaly. Similarly to the RESPONSE trial, it demonstrated superiority of ruxolitinib over standard therapy in terms of hematocrit control at 28 weeks.PubMedCrossRef •• Passamonti F, Griesshammer M, Palandri F, Egyed M, Benevolo G, Devos T, et al. Ruxolitinib for the treatment of inadequately controlled polycythaemia vera without splenomegaly (RESPONSE-2): a randomised, open-label, phase 3b study. Lancet Oncol. 2017;18(1):88–99. This randomized trial was similarly designed to RESPONSE but included PV patients without splenomegaly. Similarly to the RESPONSE trial, it demonstrated superiority of ruxolitinib over standard therapy in terms of hematocrit control at 28 weeks.PubMedCrossRef
93.
Zurück zum Zitat Passamonti F, Palandri F, Saydam G, Callum J, Devos T, Guglielmelli P, et al. Ruxolitinib versus best available therapy in inadequately controlled polycythaemia vera without splenomegaly (RESPONSE-2): 5-year follow up of a randomised, phase 3b study. Lancet Haematol. 2022;9(7):e480–92.PubMedCrossRef Passamonti F, Palandri F, Saydam G, Callum J, Devos T, Guglielmelli P, et al. Ruxolitinib versus best available therapy in inadequately controlled polycythaemia vera without splenomegaly (RESPONSE-2): 5-year follow up of a randomised, phase 3b study. Lancet Haematol. 2022;9(7):e480–92.PubMedCrossRef
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Zurück zum Zitat Masciulli A, Ferrari A, Carobbio A, Ghirardi A, Barbui T. Ruxolitinib for the prevention of thrombosis in polycythemia vera: a systematic review and meta-analysis. Blood Adv. 2020;4(2):380–6.PubMedPubMedCentralCrossRef Masciulli A, Ferrari A, Carobbio A, Ghirardi A, Barbui T. Ruxolitinib for the prevention of thrombosis in polycythemia vera: a systematic review and meta-analysis. Blood Adv. 2020;4(2):380–6.PubMedPubMedCentralCrossRef
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Zurück zum Zitat Alvarez-Larrán A, Garrote M, Ferrer-Marín F, Pérez-Encinas M, Mata-Vazquez MI, Bellosillo B, et al. Real-world analysis of main clinical outcomes in patients with polycythemia vera treated with ruxolitinib or best available therapy after developing resistance/intolerance to hydroxyurea. Cancer. 2022;128(13):2441–8.PubMedCrossRef Alvarez-Larrán A, Garrote M, Ferrer-Marín F, Pérez-Encinas M, Mata-Vazquez MI, Bellosillo B, et al. Real-world analysis of main clinical outcomes in patients with polycythemia vera treated with ruxolitinib or best available therapy after developing resistance/intolerance to hydroxyurea. Cancer. 2022;128(13):2441–8.PubMedCrossRef
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Zurück zum Zitat Wolach O, Sellar RS, Martinod K, Cherpokova D, McConkey M, Chappell RJ, et al. Increased neutrophil extracellular trap formation promotes thrombosis in myeloproliferative neoplasms. Sci Transl Med. 2018;10(436):eaan8292.PubMedPubMedCentralCrossRef Wolach O, Sellar RS, Martinod K, Cherpokova D, McConkey M, Chappell RJ, et al. Increased neutrophil extracellular trap formation promotes thrombosis in myeloproliferative neoplasms. Sci Transl Med. 2018;10(436):eaan8292.PubMedPubMedCentralCrossRef
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Zurück zum Zitat Mesa R, Vannucchi AM, Yacoub A, Zachee P, Garg M, Lyons R, et al. The efficacy and safety of continued hydroxycarbamide therapy versus switching to ruxolitinib in patients with polycythaemia vera: a randomized, double-blind, double-dummy, symptom study (RELIEF). Br J Haematol. 2017;176(1):76–85.PubMedCrossRef Mesa R, Vannucchi AM, Yacoub A, Zachee P, Garg M, Lyons R, et al. The efficacy and safety of continued hydroxycarbamide therapy versus switching to ruxolitinib in patients with polycythaemia vera: a randomized, double-blind, double-dummy, symptom study (RELIEF). Br J Haematol. 2017;176(1):76–85.PubMedCrossRef
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Zurück zum Zitat • Harrison CN, Mead AJ, Panchal A, Fox S, Yap C, Gbandi E, et al. Ruxolitinib vs best available therapy for ET intolerant or resistant to hydroxycarbamide. Blood. 2017;130(17):1889–97. This randomized trial suggested that ruxolitinib may not be superior to current second-line treatments for ET.PubMedPubMedCentralCrossRef • Harrison CN, Mead AJ, Panchal A, Fox S, Yap C, Gbandi E, et al. Ruxolitinib vs best available therapy for ET intolerant or resistant to hydroxycarbamide. Blood. 2017;130(17):1889–97. This randomized trial suggested that ruxolitinib may not be superior to current second-line treatments for ET.PubMedPubMedCentralCrossRef
99.
Zurück zum Zitat Verstovsek S, Amoloja T, Scherber RM, Yu J. Real-world patient characteristics and treatment patterns of ruxolitinib among patients with advanced essential thrombocythemia at community clinical practice. Leuk Res. 2021;110: 106711.PubMedCrossRef Verstovsek S, Amoloja T, Scherber RM, Yu J. Real-world patient characteristics and treatment patterns of ruxolitinib among patients with advanced essential thrombocythemia at community clinical practice. Leuk Res. 2021;110: 106711.PubMedCrossRef
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Zurück zum Zitat •• Sørensen AL, Mikkelsen SU, Knudsen TA, Bjørn ME, Andersen CL, Bjerrum OW, et al. Ruxolitinib and interferon-α2 combination therapy for patients with polycythemia vera or myelofibrosis: a phase II study. Haematologica. 2020;105(9):2262–72. This “proof of concept” study of ruxolitinib and interferon combination has shown excellent efficacy and safety for the treatment of patients with PV who were resistant or refractory to pegylated interferon.PubMedPubMedCentralCrossRef •• Sørensen AL, Mikkelsen SU, Knudsen TA, Bjørn ME, Andersen CL, Bjerrum OW, et al. Ruxolitinib and interferon-α2 combination therapy for patients with polycythemia vera or myelofibrosis: a phase II study. Haematologica. 2020;105(9):2262–72. This “proof of concept” study of ruxolitinib and interferon combination has shown excellent efficacy and safety for the treatment of patients with PV who were resistant or refractory to pegylated interferon.PubMedPubMedCentralCrossRef
101.
Zurück zum Zitat Chifotides HT, Bose P, Verstovsek S. Givinostat: an emerging treatment for polycythemia vera. Expert Opinion Investig Drugs. 2020;29(6):525–36.CrossRef Chifotides HT, Bose P, Verstovsek S. Givinostat: an emerging treatment for polycythemia vera. Expert Opinion Investig Drugs. 2020;29(6):525–36.CrossRef
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Zurück zum Zitat Rambaldi A, Dellacasa CM, Finazzi G, Carobbio A, Ferrari ML, Guglielmelli P, et al. A pilot study of the histone-deacetylase inhibitor givinostat in patients with JAK2V617F positive chronic myeloproliferative neoplasms. Br J Haematol. 2010;150(4):446–55.PubMed Rambaldi A, Dellacasa CM, Finazzi G, Carobbio A, Ferrari ML, Guglielmelli P, et al. A pilot study of the histone-deacetylase inhibitor givinostat in patients with JAK2V617F positive chronic myeloproliferative neoplasms. Br J Haematol. 2010;150(4):446–55.PubMed
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Zurück zum Zitat Rambaldi A, Iurlo A, Vannucchi AM, Noble R, von Bubnoff N, Guarini A, et al. Safety and efficacy of the maximum tolerated dose of givinostat in polycythemia vera: a two-part phase Ib/II study. Leukemia. 2020;34(8):2234–7.PubMedPubMedCentralCrossRef Rambaldi A, Iurlo A, Vannucchi AM, Noble R, von Bubnoff N, Guarini A, et al. Safety and efficacy of the maximum tolerated dose of givinostat in polycythemia vera: a two-part phase Ib/II study. Leukemia. 2020;34(8):2234–7.PubMedPubMedCentralCrossRef
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Zurück zum Zitat Rambaldi A, Iurlo A, Vannucchi AM, Martino B, Guarini A, Ruggeri M, et al. Long-term safety and efficacy of givinostat in polycythemia vera: 4-year mean follow up of three phase 1/2 studies and a compassionate use program. Blood Cancer J. 2021;11:53.PubMedPubMedCentralCrossRef Rambaldi A, Iurlo A, Vannucchi AM, Martino B, Guarini A, Ruggeri M, et al. Long-term safety and efficacy of givinostat in polycythemia vera: 4-year mean follow up of three phase 1/2 studies and a compassionate use program. Blood Cancer J. 2021;11:53.PubMedPubMedCentralCrossRef
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Zurück zum Zitat • Finazzi G, Vannucchi AM, Martinelli V, Ruggeri M, Nobile F, Specchia G, et al. A phase II study of givinostat in combination with hydroxycarbamide in patients with polycythaemia vera unresponsive to hydroxycarbamide monotherapy. Br J Haematol. 2013;161(5):688–94. This phase 2 study demonstrated favorable efficacy and safety of a combination therapy with givinostat and hydroxyurea for the treatment of hydroxyurea-resistant PV.PubMedCrossRef • Finazzi G, Vannucchi AM, Martinelli V, Ruggeri M, Nobile F, Specchia G, et al. A phase II study of givinostat in combination with hydroxycarbamide in patients with polycythaemia vera unresponsive to hydroxycarbamide monotherapy. Br J Haematol. 2013;161(5):688–94. This phase 2 study demonstrated favorable efficacy and safety of a combination therapy with givinostat and hydroxyurea for the treatment of hydroxyurea-resistant PV.PubMedCrossRef
106.
Zurück zum Zitat Jutzi JS, Kleppe M, Dias J, Staehle HF, Shank K, Teruya-Feldstein J, et al. LSD1 inhibition prolongs survival in mouse models of MPN by selectively targeting the disease clone. Hemasphere. 2018;2(3): e54.PubMedPubMedCentralCrossRef Jutzi JS, Kleppe M, Dias J, Staehle HF, Shank K, Teruya-Feldstein J, et al. LSD1 inhibition prolongs survival in mouse models of MPN by selectively targeting the disease clone. Hemasphere. 2018;2(3): e54.PubMedPubMedCentralCrossRef
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Zurück zum Zitat Palandri F, Vianelli N, Ross DM, Cochrane T, Lane SW, Larsen SR, et al. A phase 2 study of the LSD1 inhibitor Img-7289 (bomedemstat) for the treatment of essential thrombocythemia (ET). Blood. 2021;138(Supplement 1):38693. Palandri F, Vianelli N, Ross DM, Cochrane T, Lane SW, Larsen SR, et al. A phase 2 study of the LSD1 inhibitor Img-7289 (bomedemstat) for the treatment of essential thrombocythemia (ET). Blood. 2021;138(Supplement 1):38693.
108.
Zurück zum Zitat •• Palandri F, Ross DM, Cochrane T, Tate C, Lane SW, Larsen SR, et al. P1033: a phase 2 study of the LSD1 inhibitor IMG-7289 (bomedemstat) for the treatment of essential thrombocythemia (ET). HemaSphere. 2022;6:923–4. This phase 2 study demonstrated the favorable efficacy and safety of bomedemstat for the treatment of hydroxyurea-resistant ET patients.PubMedCentralCrossRef •• Palandri F, Ross DM, Cochrane T, Tate C, Lane SW, Larsen SR, et al. P1033: a phase 2 study of the LSD1 inhibitor IMG-7289 (bomedemstat) for the treatment of essential thrombocythemia (ET). HemaSphere. 2022;6:923–4. This phase 2 study demonstrated the favorable efficacy and safety of bomedemstat for the treatment of hydroxyurea-resistant ET patients.PubMedCentralCrossRef
109.
Zurück zum Zitat Nakatake M, Monte-Mor B, Debili N, Casadevall N, Ribrag V, Solary E, et al. JAK2V617F negatively regulates p53 stabilization by enhancing MDM2 via La expression in myeloproliferative neoplasms. Oncogene. 2012;31(10):1323–33.PubMedCrossRef Nakatake M, Monte-Mor B, Debili N, Casadevall N, Ribrag V, Solary E, et al. JAK2V617F negatively regulates p53 stabilization by enhancing MDM2 via La expression in myeloproliferative neoplasms. Oncogene. 2012;31(10):1323–33.PubMedCrossRef
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Zurück zum Zitat Lu M, Wang X, Li Y, Tripodi J, Mosoyan G, Mascarenhas J, et al. Combination treatment in vitro with nutlin, a small-molecule antagonist of MDM2, and pegylated interferon-α 2a specifically targets JAK2V617F-positive polycythemia vera cells. Blood. 2012;120(15):3098–105.PubMedPubMedCentralCrossRef Lu M, Wang X, Li Y, Tripodi J, Mosoyan G, Mascarenhas J, et al. Combination treatment in vitro with nutlin, a small-molecule antagonist of MDM2, and pegylated interferon-α 2a specifically targets JAK2V617F-positive polycythemia vera cells. Blood. 2012;120(15):3098–105.PubMedPubMedCentralCrossRef
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Zurück zum Zitat Mascarenhas J, Passamonti F, Burbury K, El-Galaly TC, Gerds A, Gupta V, et al. The MDM2 antagonist idasanutlin in patients with polycythemia vera: results from a single-arm phase 2 study. Blood Adv. 2022;6(4):1162–74.PubMedPubMedCentralCrossRef Mascarenhas J, Passamonti F, Burbury K, El-Galaly TC, Gerds A, Gupta V, et al. The MDM2 antagonist idasanutlin in patients with polycythemia vera: results from a single-arm phase 2 study. Blood Adv. 2022;6(4):1162–74.PubMedPubMedCentralCrossRef
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Zurück zum Zitat Marcellino BK, Farnoud N, Cassinat B, Lu M, Verger E, McGovern E, et al. Transient expansion of TP53 mutated clones in polycythemia vera patients treated with idasanutlin. Blood Adv. 2020;4(22):5735–44.PubMedPubMedCentralCrossRef Marcellino BK, Farnoud N, Cassinat B, Lu M, Verger E, McGovern E, et al. Transient expansion of TP53 mutated clones in polycythemia vera patients treated with idasanutlin. Blood Adv. 2020;4(22):5735–44.PubMedPubMedCentralCrossRef
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Zurück zum Zitat Mosoyan G, Kraus T, Ye F, Eng K, Crispino JD, Hoffman R, et al. Imetelstat, a telomerase inhibitor, differentially affects normal and malignant megakaryopoiesis. Leukemia. 2017;31(11):2458–67.PubMedPubMedCentralCrossRef Mosoyan G, Kraus T, Ye F, Eng K, Crispino JD, Hoffman R, et al. Imetelstat, a telomerase inhibitor, differentially affects normal and malignant megakaryopoiesis. Leukemia. 2017;31(11):2458–67.PubMedPubMedCentralCrossRef
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Zurück zum Zitat • Baerlocher GM, Oppliger Leibundgut E, Ottmann OG, Spitzer G, Odenike O, McDevitt MA, et al. Telomerase inhibitor imetelstat in patients with essential thrombocythemia. N Engl J Med. 2015;373(10):920–8. This study demonstrated excellent and durable hematologic and molecular responses to imetelstat in ET patients refractory or intolerant to hydroxyurea.PubMedCrossRef • Baerlocher GM, Oppliger Leibundgut E, Ottmann OG, Spitzer G, Odenike O, McDevitt MA, et al. Telomerase inhibitor imetelstat in patients with essential thrombocythemia. N Engl J Med. 2015;373(10):920–8. This study demonstrated excellent and durable hematologic and molecular responses to imetelstat in ET patients refractory or intolerant to hydroxyurea.PubMedCrossRef
115.
Zurück zum Zitat Ginzburg YZ, Feola M, Zimran E, Varkonyi J, Ganz T, Hoffman R. Dysregulated iron metabolism in polycythemia vera: etiology and consequences. Leukemia. 2018;32(10):2105–16.PubMedPubMedCentralCrossRef Ginzburg YZ, Feola M, Zimran E, Varkonyi J, Ganz T, Hoffman R. Dysregulated iron metabolism in polycythemia vera: etiology and consequences. Leukemia. 2018;32(10):2105–16.PubMedPubMedCentralCrossRef
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Zurück zum Zitat •• Hoffman R, Kremyanskaya M, Ginzburng Y, Kuykendall AT, Pemmarayu N, Yacoub A, et al. Rusfertide (PTG-300) controls hematocrit levels and essentially eliminates phlebotomy requirement in polycythemia vera patients. Abstract #388. Presented at the 2021 American Society of Hematology Annual Meeting, December 12, 2021.This study demonstrated excellent safety and efficacy of rusfertide, a hepcidin mimetic, in controlling hematocrit <45% without the need for phlebotomies. •• Hoffman R, Kremyanskaya M, Ginzburng Y, Kuykendall AT, Pemmarayu N, Yacoub A, et al. Rusfertide (PTG-300) controls hematocrit levels and essentially eliminates phlebotomy requirement in polycythemia vera patients. Abstract #388. Presented at the 2021 American Society of Hematology Annual Meeting, December 12, 2021.This study demonstrated excellent safety and efficacy of rusfertide, a hepcidin mimetic, in controlling hematocrit <45% without the need for phlebotomies.
117.
Zurück zum Zitat Yelena Ginzburg, Kamini Kirubamoorthy, Sinari Salleh, Lee S-E, Lee JH, Selvaratnam V, et al. Rusfertide (PTG-300) Induction therapy rapidly achieves hematocrit control in polycythemia vera patients without the need for therapeutic phlebotomy. Abstract #390. Presented at the 2021 American Society of Hematology Annual Meeting, December 12, 2021. Yelena Ginzburg, Kamini Kirubamoorthy, Sinari Salleh, Lee S-E, Lee JH, Selvaratnam V, et al. Rusfertide (PTG-300) Induction therapy rapidly achieves hematocrit control in polycythemia vera patients without the need for therapeutic phlebotomy. Abstract #390. Presented at the 2021 American Society of Hematology Annual Meeting, December 12, 2021.
118.
Zurück zum Zitat Hoffman R, Ginzburg Y, Kremyanskaya M, Khanna S, Modi N, Valone FH, et al. Rusfertide (PTG-300) treatment in phlebotomy-dependent polycythemia vera patients. J Clin Oncol. 2022;40(16_suppl):7003–7003.CrossRef Hoffman R, Ginzburg Y, Kremyanskaya M, Khanna S, Modi N, Valone FH, et al. Rusfertide (PTG-300) treatment in phlebotomy-dependent polycythemia vera patients. J Clin Oncol. 2022;40(16_suppl):7003–7003.CrossRef
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Zurück zum Zitat Verstovsek S, Kuykendall AT, Hoffman R, Ginzburg Y, Pemmaraju N, Valone F, et al. A phase 3 study of the hepcidin mimetic rusfertide (PTG-300) in patients with polycythemia vera. Blood. 2021;138(Supplement 1):1504.CrossRef Verstovsek S, Kuykendall AT, Hoffman R, Ginzburg Y, Pemmaraju N, Valone F, et al. A phase 3 study of the hepcidin mimetic rusfertide (PTG-300) in patients with polycythemia vera. Blood. 2021;138(Supplement 1):1504.CrossRef
Metadaten
Titel
Advances in Risk Stratification and Treatment of Polycythemia Vera and Essential Thrombocythemia
verfasst von
Ivan Krecak
Marko Lucijanic
Srdan Verstovsek
Publikationsdatum
06.08.2022
Verlag
Springer US
Erschienen in
Current Hematologic Malignancy Reports / Ausgabe 5/2022
Print ISSN: 1558-8211
Elektronische ISSN: 1558-822X
DOI
https://doi.org/10.1007/s11899-022-00670-8

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