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Treatment of polycythemia vera: use of 32P alone or in combination with
maintenance therapy using hydroxyurea in 461 patients greater than 65 years
of age. The French Polycythemia Study Group
Y Najean and JD Rain
Service de Medecine Nucleaire, Hopital Saint-Louis, Paris, France.
Despite myelosuppression, polycythemic (PV) patients greater than 65 years
of age have a high risk of vascular complications, and the leukemic risk
exceeds 15% after 12 years. Is the addition of low-dose maintenance
treatment with hydroxyurea (HU) after radiophosphorus (32P)
myelosuppression able to decrease these complications? Since the end of
1979, 461 patients were randomized to receive (or not) low-dose HU (5 to 10
mg/kg/d), after the first 32P-induced remission, and were observed until
death or June 1996. Maintenance treatment very significantly prolonged the
duration of 32P-induced remissions and reduced the annual mean dose
received to one-third. However, despite this maintenance, 25% of the
patients had an excessive platelet count and the rate of serious vascular
complications was not decreased, except in the most severe cases with
short-term relapse of polycythemia. Furthermore, the leukemia rate was
significantly increased beyond 8 years and a significant excess of
carcinomas was also observed. The continuous use of HU did not decrease the
risk of progression to myelofibrosis (incidence of 20% after 15 years).
Life expectancy was shorter (a median of 9.3 years v 10.9 years with 32P
alone), except in the most severe cases (initial 32P-induced remission
lasting <2 years) in which maintenance treatment moderately prolonged
the survival by reducing the vascular risk. In most cases of PV, in which
the duration of the first 32P-induced remission exceeded 2 years, the
introduction of HU maintenance did not reduce the vascular risk. Although
it considerably decreased the mean dose of 32P received, HU maintenance
therapy significantly increased the leukemia and cancer risks and reduced
the mean life expectancy by 15%. However, in cases with more rapid
recurrence, the introduction of maintenance treatment reduced the vascular
risks and moderately prolonged survival. The use of HU as a maintenance
therapy is therefore only justified in this situation.
Volume 89,
Issue 7,
pp. 2319-2327,
04/01/1997
Copyright © 1997 by The American Society of Hematology
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