Two clinicians talk about hydroxyurea vs. pegylated interferon

Yup, age matters. In fact it's the most important factor that two
Italian hematologists consider when they prescribe treatment
for ET patients.

Drs. Elisa Rumi and Mario Cazzola, two Italian hematologists, discussed how they treat ET patients in this fall's issue of Blood Journal.

While the docs are clearly up on all the latest info, and they "slice and dice" patients by mutation, risk, age, familial factors, etc. ... they pretty much come up with just three three different first-line treatments: Baby aspirin only, aspirin + hydroxyurea (Hydrea), or aspirin + pegylated interferon (Pegasys). Age seems to be the determining factor in who gets what.

Rumi and Cazzola break patients into two groups: low and high risk. Those at low risk for clots are anyone under 60 years old with no previous thrombosis and platelet counts under a million. Everybody else is high risk. (Age alone puts me in the high risk category by this standard, though my hematologist isn't persuaded that age alone should be a factor.)

Low risk patients get aspirin.

Those in the high risk category are given aspirin plus chemo. Patients under 40 are steered toward peg interferon. Those age 40-60 receive pegylated interferon or hydroxyurea after discussing pros and cons with the docs. Those over 60 are steered toward hydroxyurea as the first line of defense. Type of mutation does not enter into the decisions here. (Second line of defense meds include anagrylide (Agrylin) or busulfan.)

Rumi and Cazzola note that pegylated interferon is off-label for ET. However, there are indications that it targets the actual mutation(s) that causes ET, not just the high platelet counts. There is some idea that peg interferon could cause remission.

Why the difference in medication based on age? Hydroxyurea is considered to have fewer side effects than peg interferon, which seems to be the primary reason older people get it. Younger people, who might best benefit from remission of the disease and better tolerate the side effects, get peg interferon. The doctors note that there is no evidence that hydroxyurea increases the chances of developing leukemia. Presumably, if there is a link, older patients would die of something else before developing it.

I expect that as differences between CALR and JAK2 forms of ET are studied more, treatments may vary for patients along mutation lines. CALR patients seem to have far fewer problems with clots, and more problems with bleeding than JAK2.

In addition, protocols vary by clinician. What's your doc telling you?

Be well!

Related: I've written lots about various chemos on this blog; you may want to use the search box (upper left) to search for more about Hydrea and interferon.

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