Ruben Mesa talks about the clinical assessments involved in identifying inadequately controlled polycythemia vera (PV), and discusses strategies to help to improve the quality of life of patients with PV.
Disclosures: Ruben Mesa is a consultant to Novartis, Ariad and Galena, and has received research support from Incyte, Gilead, CTI, Promedior and Celgene.
FILMED AT THE EUROPEAN HEMATOLOGY ASSOCIATION (EHA) ANNUAL MEETING, JUNE 2016
WHEN A PATIENT PRESENTS TO YOUR CLINIC, WHAT ARE THE TYPICAL THINGS YOU WOULD DO? DO YOU OR YOUR NURSE PERFORM SYMPTOM ASSESSMENTS?
00:11 – When a patient presents to our clinic with a myeloproliferative neoplasm we really try to do a comprehensive assessment. We start with our physical exam and really looking for everything from muscle wasting to splenomegaly, to erythromelalgia. We look certainly at the blood counts and in particular with close look to the peripheral smear. And then we have patients fill out a questionnaire regarding their symptoms with their NPN, in the waiting room before they visit with us. We use the NPN 10, 10 items that give us a good sense of where their disease stands in terms of their symptoms and then we try to triangulate all these aspects to see where they stand with their disease.
HOW WOULD YOU TIPICALLY IDENTIFY AN INADEQUATELY CONTROLLED POLYCYTHEMIA VERA (PV) PATIENT?
00:59 – An inadequately controlled PV patient might have many different components, or let’s say different phenotypes that they might have. Its ongoing phlebotomy need well into therapy where they really should have already exhausted that need. It’s uncontrolled leucocytosis. It’s difficult to manage symptoms. It’s really failure of current therapy with hydroxyurea because they’re intolerant, mouth ulcers, leg ulcers, they have neutropenia, or they’re resistant, they’re on a full dose of cytoreductive therapy and really they’re in counter control, their spleen is enlarged, they have too many symptoms. Any one of those can really be a sign of inadequately controlled disease or clearly, if people have all of them, it’s really quite poorly controlled.
WHEN CONSULTING A PATIENT ON HOW TO MANAGE THEIR PV, WHAT TYPE OF THINGS DO YOU TELL THEM TO AVOID OR WHAT SUGGESTIONS WOULD YOU MAKE TO IMPROVE THEIR QUALITY OF LIFE?
01:59 – One, it’s a common question when patients have PV, they ask, “Are there things that I should avoid or things that I should be doing?” In terms of things that they should avoid, I try to take some of the stress away from them in that there’s really not a strong contraindication that we know about at the moment for avoiding, you know, avoiding foods with iron, or things of that nature. I do certainly have them avoid iron supplementation. In terms of things that they should be doing is again really being active. We know physical activity, being active, helps to combat the fatigue, helps certainly in terms of risk of blood clots and other difficulties. Additionally, really, education around their disease, in part to try to decrease some of the stress they can have with the disease. I think the better patients are informed about their disease, as well as where they stand, that could have a very favourable impact in terms of their stress.