Disclaimer: To protect patient privacy, this question has been edited slightly to omit identifying details.

A Patient Power reader asked, “I am a patient with essential thrombocythemia (ET) who was diagnosed in my early 50s and am now in my 60s. I’ve been taking hydroxyurea (Hydrea). I’m considered low-risk and do not have any of the three mutations (JAK2, CALR, or MPL). Are there reasons why I should continue taking hydroxyurea?”

Expert Response

“Possibly yes,” said Ruben Mesa, MD, president and executive director of both Atrium Health Levine Cancer Institute and Atrium Health Wake Forest Baptist Comprehensive Cancer Center – and vice dean for cancer programs at Wake Forest University School of Medicine.

The reasons patients with ET take hydroxyurea is “based on counts, symptom control, and cardiovascular risk,” Dr. Mesa said. Long-acting interferons have also been used in this setting.

Hydroxyurea is commonly used as an initial agent for patients who require cytoreduction, or a reduction of cells, with ET. It’s been around for a long time, so physicians are familiar with it and the adverse effects, which include nausea and vomiting, low white or red blood cell counts, sores, and ulcerations of the skin that don’t heal while you’re on the drug. So, if the patient is tolerating it, then the benefits of taking it may outweigh these potential adverse effects.

However, your clinician would “need to be certain your diagnosis as being ‘triple negative’ is correct, using bone marrow and other tests.”

Up to 20% of patients are triple negative, meaning they don’t have the three mutations (JAK2, CALR, or MPL). If you are among this group, you will be monitored closely. That’s because if a patient is triple negative, then physicians will look at their clonal driver. Do they have scarring in the bone marrow? Do they have a bigger spleen? Physicians are often more discerning about the signs of progression, because triple-negative patients can be a more aggressive group.

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