NCCN Guidelines for Patients® | Myeloproliferative Neoplasms

39 NCCN Guidelines for Patients ® : Myeloproliferative Neoplasms, 2018 4 Polycythemia vera Changing treatment Changing treatment Sometimes treatment works at first then stops. Sometimes it doesn’t work enough or at all. When one treatment fails, another treatment may be received. If PV has transformed into MF or AML, read Part 5 for treatment options. If PV hasn’t transformed, changing the type of cytoreductive treatment may be needed. Signs to change your cytoreductive treatment include: † † Severe side effects, † † Treatment stops working, † † A new blood clot, † † Acquired VWD, † † Major bleeding, † † Increasing spleen size, † † Symptoms caused by enlarged spleen, † † Symptoms caused by too many platelets, † † Rising levels of white blood cells, † † Worsening MPN symptoms, and † † Aspirin isn’t relieving symptoms. Guide 7 list options for second-line treatment. Hydroxyurea may not be an option for you. It may have stopped working or caused severe side effects. In this case, ruxolitinib may be received. More information on ruxolitinib is on page 47. Other options are hydroxyurea or interferon if not received before. 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. It is so good to talk to someone that understands what we are going through. – Jean Survivor, Polycythemia vera “ Guide 7. Second-line treatment What are the options? • Ruxolitinib if hydroxyurea no longer an option • Hydroxyurea if not received before • Interferon if not received before • Clinical trial