Is There Anything I Can Do to Prevent or Slow Progression of My MPN?

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Andrew Schorr:

Here's a question we got in from Julie.  Julie says, Is there anything that patients can do to prevent or slow progression?  I have PV, polycythemia vera, what can I do to keep it from going to myelofibrosis?   

Dr. Yacoub:

Well, this is a question that I would like to have a different answer for.  So as we have much better understanding of polycythemia vera, we have a set of fancier tools to try to predict the natural course of this disease.  We have better models to try to predict who is going to do better in their outlooks and who is going to have less likelihood of progressing versus who has more high risk of progressing.  

We still don't have the right tools to change what's going to happen.  We don't have the right tools to change the disease course yet. So there's a lot of clinical trials that are undergoing that are using novel drugs and using different approaches in order to impact the natural course of the disease.  However, we haven't yet reached the point where we have a proven tool that would mitigate that risk of transformation.  

Fortunately, the risk is small.  In polycythemia vera, it's around 10 percent every 10 years.  So 90 percent of the time we can reassure the patients that they're unlikely going to transform over the next 10 years for a myelofibrosis status or acute leukemia.  

However, unfortunately 10 percent over 10 years of the patients will suffer that concerning outcome.  As of this time, as of this year, there is a robust effort in research trying to use drugs that have a strong effect in trying to control polycythemia vera, and we're hoping that the effect of these medications over time and the results of those clinical trials over the coming years will be able to give us more tools to try to affect and impact the transformation risk.   

Among the medications that we have entertained this possibility are interferons.  So interferons work at a different, different path than the regular medications or such reductive medications.  They try to manipulate and modulate the immune system in the patient and use the immune system in trying to adjust immunity and have the body try to fight the cancer, and in addition to many different other paths that we don't understand yet, but we've noticed that patients with therapy with interferons have achieved bone marrow responses and molecular responses that we're hoping down the road will translate into changing the disease course. 

We don't know that for a fact yet.  The trials are still ongoing, and we're hoping that with long enough exposure to interferon we can promise patients such as this one that we can do something about that risk.  

Andrew Schorr:

That would be—that would be good news.  

Dr. Yacoub:

It would be wonderful, yes.  I wish I had a different answer for that question, which is a very frequently asked question, but as of now we don't have the right tools to change that answer.