A patient with JAK2 V617F-positive polycythaemia vera (PV) has haematocrit persistently >55% despite weekly phlebotomy. The patient is 68 years old. The MOST appropriate cytoreductive agent is:

• A Hydroxyurea (hydroxycarbamide) ✓
• B Anagrelide
• C Interferon-alpha as the cytoreductive agent of first choice in all patients
• D Busulfan

Explanation

ELN guidelines recommend cytoreductive therapy in high-risk PV (age ≥60 or prior thrombosis). Hydroxyurea is the first-line cytoreductive agent in older patients (≥60 years) with PV. Interferon-alpha (pegylated) is preferred as first-line in younger patients (<60), women of childbearing age, or those intolerant to HU, because it may achieve molecular remission. Anagrelide is used in essential thrombocythaemia. Busulfan is a second-line agent for refractory PV in elderly patients.

Reference: Harrison's Principles of Internal Medicine, 21st ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

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