Dr Grunwald on Monitoring Risk Factors for Disease Progression in PV

"If a patient has a history of thrombosis and we discover that a certain type of therapy may be able to help that at-risk population have a lower chance of [PV] transforming [into myelofibrosis], it stands to reason that more of these patients should be treated with that therapy. That basic understanding is helpful [for informing future research and treatment]."

Michael R. Grunwald, MD, chief, Leukemia Division, director, Transplantation and Cellular Therapy Program, Atrium Health’s Levine Cancer Institute; clinical professor, hematology and oncology, Wake Forest University School of Medicine, Bowman Gray Center for Medical Education, discusses the importance of monitoring for risk factors associated with disease progression in patients with polycythemia vera (PV), as informed by data from the real-world, observational REVEAL study (NCT02252159).

Results from the study were presented at the 2024 EHA Congress and highlighted 5 key risk factors associated with disease progression in patients with PV, Grunwald begins. These included an elevated white blood cell count, a history of thrombosis, an elevated variant allele frequency of the JAK2 mutation, the time between diagnosis and enrollment in the study, and a hematocrit level of 0.45 L/L or lower. Identifying these factors provides a foundation for stratifying risk and tailoring treatment strategies for individuals with PV, Grunwald states.

A history of thrombosis is particularly noteworthy, as it suggests that targeted therapies could mitigate the risk of progression to myelofibrosis in this population, he explains, adding that this insight underscores the need for more precise therapeutic approaches for at-risk groups. Elevated white blood cell counts and higher JAK2 variant allele frequency, already evaluated in previous studies, reaffirm their role as progression indicators, Grunwald notes.

Time since diagnosis also emerged as an intuitive risk factor, reflecting the natural course of disease progression over time, Grunwald continues. Similarly, the association between lower hematocrit levels and progression underscores the complex relationship between hematologic parameters and disease biology, he says. These findings pave the way for further research into tailored interventions, aiming to delay progression and improve outcomes for patients with PV, Grunwald concludes.