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EHA 2026 | A modern, individualized approach to managing polycythemia vera
Francesca Palandri, MD, PhD, University of Bologna, Bologna, Italy, discusses a modern approach to managing polycythemia vera (PV), emphasizing individualized treatment beyond traditional thrombotic risk stratification. She reviews current therapeutic options, including hydroxyurea, interferon, and ruxolitinib, and highlights emerging therapies targeting iron metabolism and epigenetic pathways.This interview took place at the 31st Congress of the European Hematology Association (EHA) in Stockholm, Sweden.
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Transcript
For a modern approach to polycythemia vera, I believe it is very important, first of all, to recognize that polycythemia vera is not a benign disease, but it is associated with a reduced overall survival. So it is important to acknowledge that particularly young adults carry the most disproportionate burden as they carry a cumulative risk of thrombosis and complications and also the overload of the psychological consequences of a cancer diagnosis...
For a modern approach to polycythemia vera, I believe it is very important, first of all, to recognize that polycythemia vera is not a benign disease, but it is associated with a reduced overall survival. So it is important to acknowledge that particularly young adults carry the most disproportionate burden as they carry a cumulative risk of thrombosis and complications and also the overload of the psychological consequences of a cancer diagnosis. When we approach in a modern way polycythemia vera, it is important to move from a binary thrombotic risk classification, which is, as you know, based on previous thrombosis and age, to a multidimensional evaluation of the patients, taking into account, for example, emerging biomarkers associated with thrombosis, like the JAK2 VAF and the neutrophil-to-lymphocyte ratio, but also integrating patient’s goals, comorbidities, and compliance capacity. The current treatment for polycythemia vera accounts for conventional cytoreduction, mainly hydroxyurea, but we can move forward using interferon and ruxolitinib. Ruxolitinib particularly is approved in the second line after hydroxyurea failure, and it is a particularly potent drug. It reduces the splenomegaly and the symptoms, and also in reducing the VAF of JAK2 mutations. And when we talk about interferon, we must acknowledge that ropeginterferon is FDA and EMA approved for PV. And in the long term, it shows a very high complete hematologic and molecular response rates. And these molecular response rates correlate with an improved event-free survival. So we have kind of evidence that improving the molecular response also serves as a surrogate endpoint for outcome for PV patients. And then we can also move forward, including new targets for treatment, and this includes iron metabolism modifiers, which are a very exciting field of exploration in polycythemia vera, and epigenetic drugs like mobidenstat and givinostat. So this is the future of PV.
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