TY - JOUR

T1 - A novel integrated biomarker index for the assessment of hematological responses in MPNs during treatment with hydroxyurea and interferon-alpha2

AU - Dam, Marc J. B.

AU - Pedersen, Rasmus K.

AU - Knudsen, Trine A.

AU - Andersen, Morten

AU - Ellervik, Christina

AU - Larsen, Morten Kranker

AU - Kjær, Lasse

AU - Skov, Vibe

AU - Hasselbalch, Hans C.

AU - Ottesen, Johnny T.

N1 - Publisher Copyright: © 2022 The Authors. Cancer Medicine published by John Wiley & Sons Ltd.

PY - 2023

Y1 - 2023

N2 - Background: Conventional cytoreductive therapy for patients with chronic Philadelphia-negative myeloproliferative neoplasms (MPNs) includes hydroxyurea (HU), interferon-alpha2 (IFN), and anagrelide. HU is worldwide the most used cytoreductive agent, which lowers elevated blood cell counts within days in the large majority of patients. However, some patients may experience rebound cytosis when HU is reduced due to cytopenia, thereby potentially giving rise to fluctuating cell counts during therapy. Such rapid oscillations may be harmful and potentially elicit thrombosis. Treatment with IFN gradually lowers elevated cell counts within weeks and when the dosage is reduced, the cell counts do not rapidly increase but are sustained within the normal range in the large majority of patients. Conventional hematological response criteria are among others based upon single absolute cell count values and do not take into account the relative decreases toward normal for each cell count. Materials, Methods & Results: Using serial data from the Danish DALIAH trial, we herein describe a novel integrated biomarker index for the assessment of hematological and molecular (JAK2V617F) responses in patients with MPNs during treatment with IFN or HU. Discussion: This novel tool convincingly displays the superiority of IFN versus HU in normalizing elevated cell counts. Our results need to be validated in larger studies but already now call for studies of the safety and efficacy of combination therapy during the initial treatment of patients with MPNs.

AB - Background: Conventional cytoreductive therapy for patients with chronic Philadelphia-negative myeloproliferative neoplasms (MPNs) includes hydroxyurea (HU), interferon-alpha2 (IFN), and anagrelide. HU is worldwide the most used cytoreductive agent, which lowers elevated blood cell counts within days in the large majority of patients. However, some patients may experience rebound cytosis when HU is reduced due to cytopenia, thereby potentially giving rise to fluctuating cell counts during therapy. Such rapid oscillations may be harmful and potentially elicit thrombosis. Treatment with IFN gradually lowers elevated cell counts within weeks and when the dosage is reduced, the cell counts do not rapidly increase but are sustained within the normal range in the large majority of patients. Conventional hematological response criteria are among others based upon single absolute cell count values and do not take into account the relative decreases toward normal for each cell count. Materials, Methods & Results: Using serial data from the Danish DALIAH trial, we herein describe a novel integrated biomarker index for the assessment of hematological and molecular (JAK2V617F) responses in patients with MPNs during treatment with IFN or HU. Discussion: This novel tool convincingly displays the superiority of IFN versus HU in normalizing elevated cell counts. Our results need to be validated in larger studies but already now call for studies of the safety and efficacy of combination therapy during the initial treatment of patients with MPNs.

KW - combination therapy

KW - essential thrombocythemia

KW - hydroxyurea

KW - interferon-alpha2

KW - MPN

KW - myelofibrosis

KW - novel integrated biomarker index

KW - polycythemia vera

KW - treatment responses

U2 - 10.1002/cam4.5285

DO - 10.1002/cam4.5285

M3 - Journal article

C2 - 36254099

AN - SCOPUS:85139819096

VL - 12

SP - 4218

EP - 4226

JO - Cancer Medicine

JF - Cancer Medicine

SN - 2045-7634

IS - 4

ER -