NCCN Guidelines for Patients® | Myeloproliferative Neoplasms

51 NCCN Guidelines for Patients ® : Myeloproliferative Neoplasms, 2018 There are three options if EPO ≥500 mU/mL. Danazol or another androgen are two options. Immunomodulatory agents with or without prednisone are another option. These drugs include lenalidomide, thalidomide, and pomalidomide. Another option is a clinical trial. Iron overload Iron overload is too much iron in your body. It can occur if you’ve had many red blood cell transfusions. Iron chelation is a type of drug that removes extra iron from your body. It is an option at times for low- and INT-1-risk MF. Your doctor may prescribe iron chelation if you’ve had more than 20 transfusions, blood ferritin is >2500 ng/mL, or both. Bleeding Platelet transfusion is used to treat bleeding caused by low platelets. You may also receive a transfusion if your platelet count is <10,000 m 3 . Most white blood cells should be removed from the donated blood. This will help prevent the blood from attacking your body. It also prevents you from getting CMV. Transfusions may not stop blooding. In this case, antifibrinolytic agents may be received. These drugs help your blood to clot. Infections You may be prone to infections because of the cancer, treatment, or both. Ask your doctor which vaccinations are safe for you. If you get infections often, your doctor may prescribe antibiotics. Instead of antibiotics, you may receive G-CSF or GM-CSF if you have low neutrophil counts. These medicines can cause your spleen to rupture. Thus, they should be used with caution if you have an enlarged spleen. Tumor lysis syndrome TLS ( t umor l ysis s yndrome) occurs when the waste released by dead cells is not quickly cleared out of your body. This results in kidney damage and severe blood electrolyte disturbances. It can be life threatening. Induction chemotherapy may cause TLS. Induction chemotherapy is a treatment for advanced-stage MF or AML. This treatment kills many cancer cells and results in too much waste too quickly. TLS may be prevented by drinking lots of water during chemotherapy. Decreasing uric acid levels with allopurinol or rasburicase is another option. Rasburicase may be given as the first treatment if your blast cells are quickly increasing. It may also be first received if your uric acid level is high or your kidney(s) are damaged. Heart (cardiovascular) disease Cardiovascular is a word that refers to the heart and blood vessels. Cardiovascular risk factors increase your chance for heart disease. They include high blood pressure (hypertension), diabetes, and smoking. If needed, your doctor will help you to reduce cardiovascular risk factors. Medications can help treat high blood pressure and diabetes. There are also medications that reduce cravings to smoke. Healthy living can reduce cardiovascular risk factors. Health experts can help you make and follow plans for healthy living. Such plans can focus on eating healthy foods, exercise, and taking medications as prescribed. You can also get help with a plan to quit smoking. High blood counts You may have high blood counts if you have PMF. In this case, you may receive cytoreductive treatment such as hydroxyurea. Cytoreductive treatment is sometimes received in addition to other treatments to relieve certain symptoms. 5 Myelofibrosis Supportive care