Combined plateletpheresis and cytotoxic chemotherapy for symptomatic thrombocytosis in myeloproliferative disorders

Abstract

Background. Patients with myeloproliferative disorders (MPD) may have symptomatic thrombocytosis develop that requires prompt and sustained lowering of platelet counts to avert serious thrombotic or hemorrhagic sequelae. Methods. The authors retrospectively studied the short‐ and long‐term effects of plateletpheresis combined with three different chemotherapy regimens (busulfan, hydroxyurea, or busulfan/hydroxyurea) in 30 patients with MPD with symptomatic thrombocytosis. Results. Twenty‐nine patients entered first remission (FR) with initial treatment. The average number of plateletphereses to FR was three (standard deviation [SD], ±3). Average total dose of busulfan (216 mg) and time to FR (1.6 months) were less than for previously reported patients treated without plateletphereses. Addition of hydroxyurea to busulfan decreased the number of plateletpheresis needed (P = 0.02) but did not additionally reduce the amount of busulfan needed or the time to FR. The shortest time to FR was in the hydroxyurea group (mean, 0.6 ± 0.3 months), but unmaintained remission could be achieved only in the busulfan‐treated groups. With median follow‐up of 68 months, median survival was 53 months for the busulfan group, 55 months for the hydroxyurea group, and was undefined with no deaths for the busulfan/hydroxyurea group. Neither fatal complications of recurrent symptomatic thrombocytosis nor development of acute leukemia has occurred, except for progression to blast crisis in two patients with chronic myelogenous leukemia. Conclusion. Combined plateletpheresis and chemotherapy is a rapidly effective initial treatment for patients with MPD with symptomatic thrombocytosis. With maintenance therapy or prompt treatment at relapse of disease, prolonged good quality survival can be expected. Copyright © 1993 American Cancer Society