NCCN Guidelines for Patients® | Myeloproliferative Neoplasms
29 NCCN Guidelines for Patients ® : Myeloproliferative Neoplasms, 2018 3 Essential thrombocythemia Changing treatment Guide 4 list options for second-line treatment. You may receive hydroxyurea or interferon if not received before. Anagrelide may be an option if used short-term and with caution. There may also be a clinical trial that you can join. Ask your doctor if there’s a clinical trial that’s right for you. More information on clinical trials is on page 45. Busulfan is not advised by NCCN experts. It may increase the likelihood of AML and other cancers. Guide 4. Second-line treatment What are the options? • Hydroxyurea if not received before • Interferon if not received before • Anagrelide if no other options • Clinical trial What is anagrelide? Anagrelide is a medicine that reduces the number of platelets. It works by blocking an enzyme called phospholipase A2. This stops megakaryocytes from maturing and making platelets. Anagrelide is sold as Agrylin ® . It is made as a pill to be swallowed. Your doctor will tell you what dose you need and how often to take it. Do not take anagrelide if you’re breastfeeding. The most common side effect of anagrelide is headaches. Digestive problems are also common. These include diarrhea, nausea, vomiting, abdominal pain, and gas. Other common side effects are weakness, swelling, dizziness, pain, and shortness of breath. In a large clinical trial, anagrelide caused more strokes and heart attacks than hydroxyurea and aspirin. Contact your doctor if you start having chest pain or abnormal heartbeats. The chance of bleeding is increased if you also take aspirin. Not all side effects of anagrelide are listed here. Please ask your treatment team for a complete list. If a side effect bothers you, tell your treatment team. There may be ways to help you feel better. There are also ways to prevent some side effects.