Published on February 26, 2016
Why do some essential thrombocythemia (ET) patients only require aspirin, while others need prescription medication? Who is at greater risk for blood clots or disease progression? Dr. Srdan Verstovsek of MD Anderson Cancer Center answers these questions, explaining the role of various treatment choices and how they affect quality of life and life expectancy.
Transcript | Understanding Treatment Choices for Essential Thrombocythemia (ET)
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Dr. Verstovsek, why don’t you start with the ET with these drugs? And you have pegylated interferon, too, which I guess is a little newer, too.
So the first question is diagnosis. And we talked about it. So diagnosis of ET is confirmed. It is known that ET is a relatively benign condition in terms of affecting the life expectancy. And because we don’t have real medications that would eliminate the disease, the standard practice when you see a patient with ET is to assess the risk of a blood clot in that particular person, because the therapies are aimed to decrease the blood clot risk and, obviously, prevent the complication from having a blood clot, mobility, or potentially even death from the blood clot if it’s in the brain or in the heart.
So it’s not about eliminating disease. It is about decreasing the risk of blood clotting and, along the way, improving the quality of life, preventing, perhaps, progression, if possible, in some patients to myelofibrosis, which is possible, or polycythemia vera.
But the main objective at the beginning is to control the risk. And we know that there are traditionally a couple of factors that will tell us which patients are at a high risk among the ET patients. And these are usually patients that are over 60 or had a history of blood clot. Everybody would be given low-dose aspirin to prevent platelets from sticking to each other. And patients who are at high risk that means over 60 or had a history of a blood clot are given medications to decrease the platelets. And the usual choices are on this list. The first choice depends on the country really where you are.
In United States, doctors like a lot hydroxyurea (Hydrea) as a first choice. It is a pill that is taken daily. Or anagrelide (Agrylin) is another pill that can be taken daily after Hydrea.
Or interferon—which is actually not a chemical—it’s a biological product that we all have in our body. It’s made in larger quantities in our body when we have inflammation or infections. As an injection, it can be given to patients. And it has, actually, not just the platelet lowering effect but that one particularly can perhaps even change the bone marrow environment and provide additional benefit in improving the biology of the disease. While the anagrelide and hydroxyurea are chemicals and don’t do that.
So with these efforts, we try to reduce the risk of blood clotting. And we then look at the side effects of the medications.
We want to improve the quality of life, not worsen quality of life for the sake for lowering the platelets. It’s a person. It’s not a number or a disease. We want to make people enjoy life with a good quality of life for as long as possible without toxicity, without the risk of thrombosis and look at the risk of progression along the way. This is where the additional bone marrow biopsy may jump in if there is some change.