In patients with polycythemia vera, symptom burden and blood count control may not be associated, according to results from the REVEAL study (ClinicalTrials.gov Identifier: NCT02252159) published in Clinical Lymphoma, Myeloma and Leukemia.
Researchers asked 1813 patients with polycythemia vera and complete blood count results within 30 days to complete the Myeloproliferative Neoplasm Self-Assessment Form Total Symptom Score (MPN-SAF TSS), a tool that scores 10 symptoms on a scale from 0 (absent) to 10 (worst imaginable). The scores for each symptom were totaled to yield a total symptom score (TSS) out of 100 for each patient.
Blood count criteria included hematocrit below 45%, white blood cell (WBC) count below 10 x 109/L, and platelet count of no more than 400 x 109/L; patients who met all 3 criteria were defined as having achieved complete hematologic response.
Median patient age was 67 years. At enrollment, 1614 patients (89.0%) had at least 1 controlled blood count, 1122 patients (61.9%) had at least 2 controlled blood counts, and 469 patients (25.8%) had complete hematologic response.
Mean TSS score was 20.2 for patients with no controlled counts, 18.7 for patients with 1 controlled count, 18.7 for patients with 2 controlled counts, and 19.1 for patients with 3 controlled counts (P >.05 for each control group compared with the uncontrolled group). TSS was not significantly associated with number of blood counts controlled (P =.64).
WBC control was associated with lower TSS scores (18.0 vs 20.2; P =.0036) compared with uncontrolled WBC counts. For all other blood counts, patients with controlled and uncontrolled counts reported similar TSS scores.
Fatigue, early satiety, inactivity, pruritus, and problems with concentration were the most commonly reported symptoms. Patients with no controlled counts were more likely to report severe pruritus and severe night sweats compared with patients with 1, 2, or 3 controlled counts. No other symptoms were associated with controlled blood counts.
The authors concluded that controlling blood count may be an effective way to address symptom burden. They recommended that physicians “regularly monitor symptom burden in patients with polycythemia vera and not rely exclusively on blood counts as a measurement of disease control.”
1. Grunwald MR, Burke JM, Kuter DJ, et al. Symptom burden and blood counts in patients with polycythemia vera in the United States: an analysis from the REVEAL study [published online June 12, 2019]. Clin Lymphoma Myeloma Leuk. doi:10.1016/j.clml.2019.06.001