Polycythemia Vera and Essential Thrombocythemia: When to Change Therapy – Second-Line Options

  • Alessandro M. Vannucchi
Part of the Hematologic Malignancies book series (HEMATOLOGIC)


Criteria for deciding when to shift a polycythemia vera (PV) or essential thrombocythemia (ET) patient from first-line to second-line therapy have been recently outlined in the management recommendations developed from European LeukemiaNet (ELN) experts. Reasons for second-line therapy are mainly represented by development of refractoriness or intolerance to first-line drugs, in case of high-risk patients already under treatment, or the appearance of any modifications in hematological and clinical manifestations that foresee a worsening of the underlying illness, in case of untreated low-risk subjects. Options for second-line therapy include cytotoxic drugs, interferon, or anagrelide; there is no specific consensus-based evidence on which drug to prefer, or with which priority, and choices mostly reflect the attitude and experience of the physician. Furthermore, cytotoxic drugs other than hydroxyurea used for second-line therapy might raise safety issues concerning their leukemogenic potential and should be used with caution.


Acute Leukemia Polycythemia Vera Essential Thrombocythemia Actinic Keratosis Polycythemia Vera Patient 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


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Copyright information

© Springer-Verlag Berlin Heidelberg 2012

Authors and Affiliations

  1. 1.Section of HematologyUniversity of FlorenceFlorenceItaly

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