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Blood, 15 August 2000, Vol. 96, No. 4, pp. 1582-1584

BRIEF REPORT

Hydroxyurea-induced marked oscillations of platelet counts in patients with polycythemia vera

Ayalew Tefferi, Michelle A. Elliott, Pai Chih Kao, Sooyoung Yoon, Ihab El-Hemaidi, and Thomas C. Pearson

From the Division of Hematology and Internal Medicine and the Division of Clinical Biochemistry and Immunology, Mayo Clinic and Mayo Foundation, Rochester, MN, and the Department of Haematological Medicine, St. Thomas' Hospital, London, UK.

Two prospectively studied patients with polycythemia vera (PV) whose platelet counts showed marked periodic fluctuation during treatment with hydroxyurea (HU) are reported. Cycle lengths in both were approximately 28 to 30 days. In one patient, the cyclic process was no longer evident when treatment with HU was withheld, and it reappeared on treatment rechallenge. Circulating thrombopoietin (TPO) levels fluctuated out of phase with the platelet count despite markedly reduced TPO-receptor (c-Mpl) expression in bone marrow megakaryocytes. These observations suggest that the cyclic phenomenon may be related to both a transient state of HU-induced depletion of megakaryocytes and a concentration-dependent mitigation by TPO of the HU effect on megakaryocytes and their precursors. It is conceivable that the affected patients harbor a megakaryocyte progenitor pool whose apoptotic activity is differently modulated by either HU or high concentrations of TPO.

© 2000 by The American Society of Hematology.
 

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