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Conclusions and Further Reading - Chapter 10

Chapter 10 - Management of Chronic Myeloproliferative Neoplasia (MPN) in Elderly Patients

Conclusions

  • Given the limited literature available, so far all approved TKIs have a comparable safety and efficacy profile in elderly CML patients when compared to younger CML patients. Its clinical efficacy is also far superior to other treatment modalities, which underscores the central role of TKIs as standard first-line treatment in senior CML patients.
  • Low risk PV patients should be managed with low-dose aspirin and if necessary phlebotomy (target haematocrit <45%). Special precautions for aspirin should be taken in the case of patients with greater bleeding risk or allergies. Cytoreductive therapy should be considered as an option for high-risk PV patients. Hydroxyurea and Interferon-alpha are the preferred agents and should be administered to maintain a platelet count of less than 450 x 109/L. Of note, interferon-alpha is the only known compound so far that includes a significant reduction of the JAK2 V617F allelic burden, and may be of particular interest for fit elderly individuals. If treatment with hydroxyurea is not appropriate, ruxolitinib is now approved, especially in patients with high symptom burden and/or splenomegaly.
  • All seniors with WHO-ET are at risk for thrombotic events and should be treated with anagrelide or hydroxyurea and low-dose aspirin.
  • Only very few selected and fit senior MF patients qualify for allogeneic stem cell transplantation, which is the only curative approach. Ruxolitinib is the standard for most symptomatic elderly MF patients. In the hyperproliferative phase, hydroxyurea can reduce thrombocytosis-associated vascular events. When haematopoiesis becomes insufficient, supplementation of blood products, erythropoietin, or androgens can be applied to stabilise haematopoiesis.

Further Reading

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