Vnitr Lek 2014, 60(Suppl 2):58-68

Ph-negative myeloproliferative diseases with thrombocythemia in the context of Thromboreductin® treatment, data from registry 2013

Miroslav Penka^1,*, Jiří Schwarz², Petra Ovesná³, Libor Červinek⁴, Petr Dulíček⁵, Dagmar Pospíšilová⁶, Jarmila Kissová¹, Tomáš Pavlík³, kolektiv České pracovní skupiny pro Ph-negativní myeloproliferativní onemocnění (CZEMP)

¹ Oddělení klinické hematologie FN Brno, pracoviště Bohunice, přednosta prof. MUDr. Miroslav Penka, CSc.

² Ústav hematologie a krevní transfuze Praha, ředitel prof. MUDr. Petr Cetkovský, Ph.D., MBA

³ Institut biostatistiky a analýz MU Brno, ředitel doc. RNDr. Ladislav Dušek, CSc.

⁴ Interní hematologická a onkologická klinika LF MU a FN Brno, pracoviště Bohunice, přednosta prof. MUDr. Jiří Mayer, CSc.

⁵ IV. interní hematologická klinika LF UK a FN Hradec Králové, přednosta doc. MUDr. Pavel Žák, CSc.

⁶ Dětská klinika LF UP a FN Olomouc, přednosta prof. MUDr. Vladimír Mihál, Ph.D.

Czech Working Group for Ph-negative Myeloproliferative diseases (CZEMP) recommends anagrelid (Thromboreductin®) for the treatment of Ph-negative chronic myeloproliferative disease (MPO) with thrombocythemia accompanying. To evaluate the efficacy of this treatment, the patient registry with essential thrombocythemia and/or thrombocytosis accompanying other Ph-negative myeloproliferative diseases was established. The beginnings of data collection go back to 2001, registry itself is maintained from 2005 and the aim is to archive the medical records with detailed physical and laboratory examination, safety patient profile included. The longest follow-up monitors 150 months period. Registry database contained 1,325 patients in the end of 2013, with an annual increase of anagrelid therapy as a drug of first choice in accordance with CZEMP guidelines approved by the Czech Society of Hematology of Czech Medical Association of J. E. Purkyne. Indication criteria contribute to this trend as anagrelid is the first choice agent in 65 years old patients, instead previous 60 years of age. Often, we can observe the combined treatment, especially, in older patients and in patients with primary myelofibrosis and polycythemia vera. There have been founded 543 thrombotic events in 413 patients and 63 bleeding events in 58 patients of study group by the end of 2013. During treatment, thrombosis was diagnosed 225 times in 171 patients and bleeding was observed 139 times in 104 patients. The therapeutic response is achieved after 3 months in 77% and after 6 months in 83% of subjects, but after 12 months, the treatment still fails in 12,5% of patients. It might be caused by slow titration of Thromboreductin®. One of the most important indicators of treatment success is the effect on clinical symptoms presentation, especially the occurrence of thrombotic events. The proof of a good treatment efficacy is demonstrated by 1.8 fold decrease in arterial thrombosis, more than 1.5 fold decrease in microvascular thrombosis and even 6.2 fold decrease in venous thromboembolism events. Bleeding is observed in about double more patients in comparison to the period before inclusion in the systematic monitoring, but the bleedings are clinically insignificant.

Keywords: anagrelid (Thromboreductin®); Ph-myeloproliferative diseases; registry; thrombosis

Received: September 1, 2014; Accepted: September 17, 2014; Published: April 1, 2014  Show citation