A 50-year-old woman with polycythemia vera is started on hydroxyurea. After 6 months, her WBC is 14,000/µL, hematocrit 48%, but she develops painful leg ulcers. Which alternative cytoreductive agent is most appropriate?

• A Busulfan
• B Anagrelide
• C Ruxolitinib
• D Interferon-alpha (pegylated) ✓

Explanation

Hydroxyurea-induced leg ulcers (a recognized cutaneous toxicity) require discontinuation and switching to an alternative cytoreductive agent. Pegylated interferon-alpha is the preferred alternative — it is non-leukemogenic, effective in reducing counts, and can induce molecular remissions in JAK2-mutated PV. It is particularly preferred in younger patients. Ruxolitinib (a JAK1/2 inhibitor) is approved for HU-resistant or intolerant PV. Busulfan is avoided due to leukemogenic potential. Anagrelide primarily targets platelets and is less effective for erythrocytosis.

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

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

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