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ASH 2025 | Hematocrit control among patients with high- or low-risk PV receiving SoC treatment in the US
Aaron Gerds, MD, Cleveland Clinic, Cleveland, OH, discusses a study evaluating hematocrit control among patients with high- and low-risk polycythemia vera (PV) receiving current standard of care (SoC) treatment in the United States, highlighting the challenges of maintaining hematocrit levels below 45% with current therapies. Dr Gerds notes that even with these treatments, many patients experience periods where their hematocrit levels are not well-controlled, which may increase the risk of thrombosis and other complications. This interview took place at the 67th ASH Annual Meeting and Exposition, held in Orlando, FL.
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Transcript
So for polycythemia vera, a major goal of treatment is keeping the hematocrit under 45%. And this was set, actually it was a plenary session here at ASH many years ago, where we kind of conceptualized, or at least got the data for tighter hematologic control. Again, keep that hematocrit under 45%, which is associated with less risk of thrombosis, blood clots, and blood clot associated death...
So for polycythemia vera, a major goal of treatment is keeping the hematocrit under 45%. And this was set, actually it was a plenary session here at ASH many years ago, where we kind of conceptualized, or at least got the data for tighter hematologic control. Again, keep that hematocrit under 45%, which is associated with less risk of thrombosis, blood clots, and blood clot associated death. And really though, the question is how often do we actually get there with our patients, right? We often do phlebotomies for low-risk patients. So a patient comes in, they get their blood drawn, you take a pint of blood out, and eventually make them iron deficient. But eventually that hematocrit goes back up.
You know, the patients eat food, as most people do, and replace that iron and the hematocrit can go back up. And there’s a period of time where their hematocrit may not be under 45%. Likewise, when we use cytoreductive therapy in higher risk patients, you know, things like hydroxyurea or interferons, it may not control the counts fully and all the time there. We’re constantly making adjustments of the doses of these medications in our clinics.
So with this very straightforward and simple examination of market scan data, we wanted to know how often are patients well-controlled, have the hematocrit under 45 percent. And, you know, I always use the analogy of a good old warfarin or Coumadin days, right, where, you know, you check the INR and sometimes you’re above, sometimes you’re below, but, you know, some of the time you’re in the middle in the sweet range for warfarin therapy for like say afib and such. And now with newer modern medications that kind of keep it flat all the time you know those those therapies are thought to be better like the DOACs, the direct oral anticoagulants so again pivoting back to the PV story is well if we can’t keep that hematocrit under 45 all the time is that you know adversely affecting our patients? And what we saw was that yeah phlebotomy, very rarely are the patients always under 45. And even with hydroxyurea, roughly half the patients are under 45 all the time. So really it shows that there is a massive need for better hematologic control in patients with polycythemia vera.
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