NCCN Guidelines for Patients® | Myeloproliferative Neoplasms

38 NCCN Guidelines for Patients ® : Myeloproliferative Neoplasms, 2018 4 Polycythemia vera Monitoring Monitoring After initial treatment, you will need to meet with your doctor often. A visit every 3 to 6 months is advised. You may need more frequent visits if problems arise. Guide 6 list the types of monitoring for each risk group. Status of PV Your doctor will assess if the cancer is worse. Blood tests may be done. You may complete the MPN-SAF Total Symptom Score. This survey consists of 10 symptoms. Fatigue is also queried. Each symptom is rated on a scale from 0 to 10. Higher scores point to worse symptoms. Need for cytoreductive treatment Initial treatment for low-risk PV doesn’t include cytoreductive treatment. During monitoring, your doctor will check if you need to start. Signs that treatment may be needed include: † † A new blood clot, † † Acquired VWD, † † Major bleeding, † † Frequent phlebotomy, † † Need for phlebotomies doesn’t decrease, † † Increasing spleen size, † † Symptoms caused by enlarged spleen, † † Symptoms caused by too many platelets, † † Rising levels of white blood cells, and † † Worsening MPN symptoms. Cytoreductive treatment is described on page 37. Before starting, a bone marrow aspirate and biopsy should be done. These tests can show if the cancer has progressed to MF. If it has, the treatment described in Part 5 is needed. Results of cytoreductive treatment Your doctor will assess if treatment is working based on tests. There are four types of treatment response. † † Complete remission is defined by 1) no cancer symptoms and signs for at least 12 weeks; 2) hematocrit <45% without phlebotomies and normal or near-normal blood counts for at least 12 weeks; 3) no blood clots or bleeding events and PV isn’t changing into another cancer; and 4) bone marrow consists of a normal number of cells, cells that look normal, and minor, if any, bone marrow fibrosis (Grade 0 or 1). † † Partial remission is like a complete remission except bone marrow cells are still abnormal. † † No response is less than a partial remission. † † Progressive disease is a worsening of the cancer. Guide 6. Monitoring PV by risk group Type of care Low High • Assess status of PV • Assess need for cytoreductive treatment • Assess results of cytoreductive treatment