Page 221 - Essential Haematology

Chapter 15 Myeloproliferative neoplasms / 207

thrombocytosis, weight loss or night sweats. Daily days. It is concentrated in bone and is a most eff ec-

hydroxycarbamide (hydroxyurea) is valuable in con- tive myelosuppressive agent. The usual remission
trolling the blood count and may need to be con- time after a single dose is 2 years. Concern about
tinued for many years (Fig. 15.7 ). Side - eff ects of late development of leukaemia limits its use.
hydroxyurea include myelosuppression, nausea and
skin toxicity. Busulfan, which can be used inter- Interferon
mittently, is sometimes used in older patients.
α - Interferon suppresses excess proliferation in the
Pipobroman is similar to alkyating agents and is
marrow and has produced good haematological
used in Europe but not in the UK. Th e concern
responses. It is less convenient than the oral agents
with cytotoxic drugs, especially busulfan, is that
and side - effects are frequent. It may be particularly

they may be associated with an increased rate of
valuable in controlling itching and is often used for

progression to leukaemia. This risk is low and there
patients less than 40 years old to avoid early expo-
is probably no increased risk with hydroxyurea.
sure to chemotherapy drugs.
Phosphorus - 32 t herapy Aspirin
This is only used for older patients with severe Low - dose aspirin reduces thrombotic complications

32
disease. P is a β - emitter, with a half - life of 14.3 without an increased risk of major haemorrhage.
Hydroxycarbamide (hydroxyurea) (g/day) 1.5
1.0
0.5

Spleen 0
size + 10 cm + 3 cm + 1 cm

22
Hb (g/dL) 20
18
16
14
12
40 800

30 600
WBC (x 10 9 /L) 20 Platelets 400 Platelets (x 10 9 /L)

10 200
WBC
0 0
0 2 4 6 8 10 12
Months

Figure 15.7 Haematological response to therapy with hydroxycarbamide (hydroxyurea) in polycythaemia vera.

Hb, haemoglobin; WBC, white blood cells.