b'Should Cytoreductive Therapy Be UsedIn Younger polycthemia vera Patients?NEW YORKYounger polycythemia vera pa- complications in PV60 treated with interferon tients are often symptomatic and suffer impairedalfa (rIFN) or hydroxyurea (HU).quality of life, reduced work productivity andTo do that, the researchers searched PubMed, excessmortalitycomparedwithage-matchedScopus, Web of Science and Embase to iden-controls, according to a new study. tify 693 unique studies with relevant keywords, Unfortunately,effectiveandpotentiallyofwhich14metinclusioncriteriaandwere life-prolongingcytoreductivetherapyisoftenselected for analysis.deferred in younger patients who are consideredThe weighted average age of 74 patients in 12 low-risk because of their age and lack of throm- studies treated with rIFN was 48 and for 1,397 bosis history, explained Weill Cornell MedicineineightstudiestreatedwithHUwas56.The researchers. The rationale for withholding cyto- weighted average duration of treatment for either reductivetherapyisdata-sparseanddrivenbydrug was 4.5 years. The study team determined theoreticalconcernsfortoxicityandunknownthat the pooled annual rate of discontinuation due benefits from early treatment. to toxicity was 5.2% (n=587, CI 2.2%-8.2%) for In a recent report in Blood Advances, the research- patients receiving rIFN and 3.6% (n=1097, CI erssuggestedthereissomeevidencethatearly1%-6.2%) for HU. treatment is both well tolerated and potentiallyTheaveragecompletehematologicresponse useful. The authors cited a study showing that(CHR) for rIFN and HU was 62% and 52%,young patients receiving cytoreduction with rope- Respectively, they added, with patients experi-ginterferon alfa-2b experienced no more adverseencing thrombotic events at a pooled annual rate events of grade 3 or higher than those randomizedof 0.79% and 1.26%; sMF at 1.06% and 1.62%; to treatment with phlebotomy alone, and improvedAML at 0.14% and 0.26%; and death at 0.87% quality of life, after 1-2 years of treatment. 1 and 2.65%, respectively. Yet, they pointed out, cytoreductive therapy isNo treatment-related deaths were reported, the not routinely recommended for younger patientsauthors advised. With acceptable rates of non-fatal withpolycythemiavera(PV)becauseofcon- toxicity, cytoreductive treatment, particularly with cernsthattreatmenttoxicitymightoutweighdisease-modifyingrIFN,maybenefitPV60. therapeutic benefits.Future randomized trials prioritizing inclusion of The authors argued, however, that no system- PV60 are needed to establish a long-term benefit atic data supports that approach. They embarkedof early cytoreductive treatment in these patients.onameta-analysistoprovideanobjective1Chamseddine RS, Savenkov O, Rana ST, Khalid M, Silver RT, risk/benefitassessmentofcytoreductivedrugsKucine N, Scandura JM, Abu-Zeinah G. Cytoreductive therapy in PV patients younger than 60 (PV60 or his- in younger adults with polycythemia vera: a meta-analysis of toryofthrombosis).Theirsystematicreviewsafety and outcomes. Blood Adv. 2024 Mar 20:bloodadvanc-es.2023012459. doi: 10.1182/bloodadvances.2023012459. Epub sought to evaluate toxicity and disease-relatedahead of print. PMID: 38507746.76'