NCCN Guidelines for Patients® | Myeloproliferative Neoplasms
37 NCCN Guidelines for Patients ® : Myeloproliferative Neoplasms, 2018 4 Polycythemia vera Initial treatment Cytoreductive treatment Cytoreductive treatment reduces the number of certain cells. For PV, the goal of treatment is to reduce blood cell counts to normal levels. Normal levels prevent blood clots and other health problems. Cytoreductive treatment for initial treatment is based on risk group. It is not needed for low-risk PV. Cytoreductive treatment is advised for high- risk PV. There are two options for cytoreductive treatment. Hydroxyurea is the gold standard. Most people with PV on cytoreductive treatment take hydroxyurea. It should not be taken during pregnancy or while breastfeeding. Hydroxyurea is described more on page 26. Interferon is another option for some people. You may switch from hydroxyurea to interferon before and during pregnancy. Interferon may be received if you are 60 years of age or younger to avoid a slightly increased risk for AML. Some people defer taking hydroxyurea by taking interferon. What is interferon? Interferons naturally exist in your body as part of your disease-fighting (immune) system. They can also be made in the lab and be used to treat MPN. When used as treatment, interferon is given in much higher amounts than what the body makes. How interferon works to treat MPN isn’t fully known. It is a type of immunotherapy. Thus, it enhances the activity of immune cells. A high level of interferon also suppresses the making of blood cells. It may take 6 to 12 months before your blood cell counts return to normal. Interferons for MPN are interferon alfa-2b, peginterferon alfa-2a, and peginterferon alfa-2b. They are received as an injection just under the skin. Most people inject themselves. Your doctor will tell you what dose you need and how often. Side effects of interferon are related to dose. The higher the dose the worse the side effects. Side effects may lessen over time. Some people have flu-like symptoms after several injections. Other common side effects are headache, nausea, and diarrhea. You may become depressed or have trouble concentrating or remembering. Tell your doctor if you have a history of depression. Not all side effects of interferon are listed here. Please ask your treatment team for a complete list of common and rare side effects. 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.