Chemotherapy and Drug Therapy
Drug therapy is used for polycythemia vera (PV) to lower platelet count. Your doctor may use one or more of the following drugs:
Aspirin therapy. Low-dose aspirin may lessen your risk of developing a blood clot in an artery (thrombosis). It acts by making platelets less likely to clump to an artery wall.
Anagrelide (Agrylin®). Anagrelide can be used to reduce the rate that platelets form in the marrow without affecting the other blood cells. Anagrelide may cause side effects, including fluid retention, heart and blood pressure problems, headaches, dizziness, nausea and diarrhea. Older patients and patients with heart disease are generally not treated with anagrelide.
Antihistamines or related drugs. Your doctor may prescribe an antihistamine or a related drug to relieve itchy skin, which can be a symptom of PV.
Myelosuppressive drugs. Myelosuppressive drugs are agents that can reduce red cell or platelet concentrations. In some patients, phlebotomy alone can't control the overproduction of red cells and can contribute to the platelets' overproduction. Myelosuppressive agents may be used if you have an extremely high platelet count, complications from bleeding or blood clots or other serious complications that don't respond to low-dose aspirin or phlebotomy. Your doctor may either combine drug therapy with phlebotomy or use it to replace phlebotomy to suppress your marrow's red cell and platelet production.
Hydroxyurea (Hydrea®). The most commonly used myelosuppressive agent for PV is hydroxyurea, given in pill form. It has few side effects and helps to reduce the hematocrit or hemoglobin concentration and platelet count.
Interferon alfa (Intron® A). Interferon alfa and other chemotherapy agents are available but aren't used in most patients because they're inconvenient to administer and may have frequent side effects. Interferon alfa is given by injection and is costly. Some patients develop moderately severe flu-like symptoms, confusion, depression or other complications.
Radioactive phosphorus (32p). This drug therapy is an option for older patients unable to have frequent follow-up. Longer-lasting control is possible with one or two doses given intravenously (into a vein).
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