Discussion:
Phlebotomy In Polycythemia Underused
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ironjustice
2018-12-03 12:24:34 UTC
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Recommended therapies for polycythemia vera underused
November 27, 2018

(HealthDay)—Among older patients with polycythemia vera (PV), therapeutic phlebotomy and hydroxyurea (HU) are associated with improved overall survival and decreased risk for thrombosis but are underused, according to a study recently published in Blood Advances.


Nikolai A. Podoltsev, M.D., Ph.D., from Yale University in New Haven, Connecticut, and colleagues conducted a retrospective cohort study in 820 older adults (median age, 77 years) diagnosed with PV from 2007 to 2013 using the linked Surveillance, Epidemiology, and End Results-Medicare database.

The researchers found that 16.3 percent of patients received neither phlebotomy nor HU, 23 percent were managed with phlebotomy only, 19.6 percent were managed with HU only, and 41.1 percent were managed with both treatments. During a median of 2.83 years of follow-up, 37.2 percent of patients died. Lower mortality was significantly associated with phlebotomy (yes/no; hazard ratio [HR], 0.65), increasing phlebotomy intensity (HR, 0.71), and a higher proportion of days covered by HU. There was a lower risk for thrombotic events associated with phlebotomy (yes/no; HR, 0.52) and increasing phlebotomy intensity (HR, 0.46). A higher proportion of days covered by HU was also associated with a significantly lower risk for thrombotic events.

"In this population-based study of older adults with PV reflecting contemporary clinical practice, phlebotomy and HU were associated with improved overall survival and decreased risk of thrombosis," the authors write. "However, both treatment modalities were underused."

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ironjustice
2018-12-03 13:04:07 UTC
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The impact of phlebotomy and hydroxyurea on survival and risk of thrombosis among older patients with polycythemia vera
Nikolai A. Podoltsev, Mengxin Zhu, Amer M. Zeidan, Rong Wang, Xiaoyi Wang, Amy J. Davidoff, Scott F. Huntington, Smith Giri, Steven D. Gore and Xiaomei Ma
Blood Advances 2018 2:2681-2690; doi: https://doi.org/10.1182/bloodadvances.2018021436
ArticleFigures & DataInfo & Metrics PDF
Key Points
Treatments with therapeutic phlebotomy and HU are associated with improved OS and decreased risk of thrombosis in older PV patients.

Phlebotomy and HU are underused in our sample of older PV patients.

Abstract
Current guidelines recommend therapeutic phlebotomy for all polycythemia vera (PV) patients and additional cytoreductive therapy (eg, hydroxyurea [HU]) for high-risk PV patients. Little is known about the impact of these therapies in the real-world setting. We conducted a retrospective cohort study of older adults diagnosed with PV from 2007 to 2013 using the linked Surveillance, Epidemiology, and End Results–Medicare database. Multivariable Cox proportional hazards models were used to assess the effect of phlebotomy and HU on overall survival (OS) and the occurrence of thrombotic events. Of 820 PV patients (median age = 77 years), 16.3% received neither phlebotomy nor HU, 23.0% were managed with phlebotomy only, 19.6% with HU only, and 41.1% with both treatments. After a median follow-up of 2.83 years, 37.2% (n = 305) of the patients died. Phlebotomy (yes/no; hazard ratio [HR] = 0.65; 95% confidence interval [CI], 0.51-0.81; P < .01), increasing phlebotomy intensity (HR = 0.71; 95% CI, 0.65-0.79; P < .01), and a higher proportion of days covered (PDC) by HU were all significantly associated with lower mortality. When thrombosis was the outcome of interest, phlebotomy (yes/no; HR = 0.52; 95% CI, 0.42-0.66; P < .01) and increasing phlebotomy intensity (HR = 0.46; 95% CI, 0.29-0.74; P < .01) were significantly associated with a lower risk of thrombotic events, so was a higher HU PDC. In this population-based study of older adults with PV reflecting contemporary clinical practice, phlebotomy and HU were associated with improved OS and decreased risk of thrombosis. However, both treatment modalities were underused in this cohort of older PV patients.

http://www.bloodadvances.org/content/2/20/2681?rss=1&sso-checked=true

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Post by ironjustice
Recommended therapies for polycythemia vera underused
November 27, 2018
(HealthDay)—Among older patients with polycythemia vera (PV), therapeutic phlebotomy and hydroxyurea (HU) are associated with improved overall survival and decreased risk for thrombosis but are underused, according to a study recently published in Blood Advances.
Nikolai A. Podoltsev, M.D., Ph.D., from Yale University in New Haven, Connecticut, and colleagues conducted a retrospective cohort study in 820 older adults (median age, 77 years) diagnosed with PV from 2007 to 2013 using the linked Surveillance, Epidemiology, and End Results-Medicare database.
The researchers found that 16.3 percent of patients received neither phlebotomy nor HU, 23 percent were managed with phlebotomy only, 19.6 percent were managed with HU only, and 41.1 percent were managed with both treatments. During a median of 2.83 years of follow-up, 37.2 percent of patients died. Lower mortality was significantly associated with phlebotomy (yes/no; hazard ratio [HR], 0.65), increasing phlebotomy intensity (HR, 0.71), and a higher proportion of days covered by HU. There was a lower risk for thrombotic events associated with phlebotomy (yes/no; HR, 0.52) and increasing phlebotomy intensity (HR, 0.46). A higher proportion of days covered by HU was also associated with a significantly lower risk for thrombotic events.
"In this population-based study of older adults with PV reflecting contemporary clinical practice, phlebotomy and HU were associated with improved overall survival and decreased risk of thrombosis," the authors write. "However, both treatment modalities were underused."
Who loves ya.
Tom
Jesus Was A Vegetarian!
http://tinyurl.com/634q5a
Man Is A Herbivore!
http://tinyurl.com/4rq595
DEAD PEOPLE WALKING
http://tinyurl.com/zk9fk
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