A 55-year-old man with polycythaemia vera and JAK2 V617F mutation has a haematocrit persistently above 45% despite phlebotomy and low-dose aspirin. He has had one prior venous thromboembolic event. What is the next appropriate cytoreductive agent?
- A Hydroxyurea ✓
- B Ruxolitinib
- C Interferon-alpha
- D Anagrelide
Correct answer: A. Hydroxyurea
Explanation
Hydroxyurea is the first-line cytoreductive agent for high-risk PV (age > 60 or prior thrombosis), effective in maintaining haematocrit < 45% (CYTOPV trial) and reducing thrombotic events. Ruxolitinib (JAK1/2 inhibitor) is second-line after hydroxyurea resistance or intolerance (RESPONSE trial). Interferon-alpha is preferred in young patients or women of childbearing age due to its ability to reduce JAK2 allele burden. Anagrelide primarily targets platelets and is used in ET, not PV.
Reference: Harrison's Principles of Internal Medicine, 21st ed.
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