Patterns of hydroxyurea use and clinical outcomes among patients with polycythemia vera in real-world clinical practice: a chart review

Abstract

BackgroundHydroxyurea (HU) is among the most commonly used cytoreductive treatments for polycythemia vera (PV), but previous research and clinical experience suggest that not all patients respond optimally, consistently, or durably to HU treatment. This study investigated patterns of HU use and impact on disease control among patients with PV in real-world clinical practice in the United States.MethodsOncologists and hematologists recruited between April and July 2014 reported data from patient charts. Treatment history and disease symptom comparisons between HU subgroups were performed using Chi square tests or one-way analyses of variance for categorical and continuous variables. Other analyses were performed using descriptive statistics.ResultsOverall, 329 physicians participated and provided data on 1309 patients with PV (62.3 % male; mean age = 62.5 years, mean time since diagnosis = 5.2 years). In the 229 (17.5 %) patients who had stopped HU, the most common reasons for HU discontinuation—as assessed by the treating clinician—were inadequate response (29.3 %), intolerance (27.5 %), and disease progression (12.7 %). Among patients currently on HU, a significant proportion had elevated blood cell counts: 34.4 % had hematocrit values ≥45 %, 59.4 % had platelet levels >400 × 109/L, and 58.2 % had WBC counts > 10 × 109/L. Two-thirds (66.3 %) of patients had ≥1 elevated count, 40.3 % had ≥2 elevated counts, and 19.8 % had all 3 counts elevated. The most common PV-related signs and symptoms among all patients were fatigue and splenomegaly.ConclusionsAlthough many patients with PV benefit from HU therapy, some continue to have suboptimal control of their disease, as evidenced by persistence of abnormally elevated blood cell counts and the continued experience of disease-related manifestations (signs and symptoms). These data further denote a significant medical need for some patients with PV currently or previously treated with HU.Electronic supplementary materialThe online version of this article (doi:10.1186/s40164-016-0031-8) contains supplementary material, which is available to authorized users.

Profile of Polycythemia Vera in Campus Teaching Hospital of Lome - Togo

“…Indeed Parasuraman S in there serie of 1309 patients, the average age was 62.5 years. [23]. As against our results are relatively similar to those of the series of Mahjoub S. et al [22] in Tunisie who find a average age at 53 years in a cohort of 22 patients.…”

Disease and treatment characteristics of polycythemia vera patients in Belgium: Results from a scientific survey

“…In HU‐treated patients, 81 patients (28.4%) had a hematocrit >45%, 88 patients (30.9%) had leukocyte counts >10 × 10 9 /L, and 97 patients (34%) had platelet counts >400 × 10 9 /L. An extensive recent study that provided data for 1080 HU‐treated patients reported rates similar to those in our study for hematocrit >45% (34.4%), but higher rates for platelet >400 × 10 9 /L (59.4%) and WBC >10 × 10 9 /L (58.2%) counts …”

Polycythemia Vera Management and Challenges in the Community Health Setting

“…First, eligible patients were hydroxyurea-resistant/intolerant; however, 59% in the BAT group continued hydroxyurea treatment [8] . This management approach was consistent with real-world practice before regulatory approval of ruxolitinib, in which some physicians continued hydroxyurea despite diminished benefit because of limited alternative treatment options [8,27] . Furthermore, in subgroup analyses by treatment type in the BAT arm, ruxolitinib was associated with greater clinical benefit at week 32 versus nonhydroxyurea treatment options for achievement of a ≥ 35% reduction from baseline in spleen volume (40 vs. 0%, respectively), hematocrit control without phlebotomy (60 vs. 16%) [8,25] , and a ≥ 50% improvement from baseline in MPN-SAF TSS (49 vs. 6%) [28] .…”