Myeloproliferative Neoplasms   

Secondary MF such as post-PV, for example. Do you apply the same prognostic scoring systems? 

No evidence of palpable splenomegaly, normal hematocrit and platelet count

ET is JAK2+

Recurrent thromboses despite therapeutic enoxaparin. Other hypercoagulable work-up negative. 

Would pegylated interferon be preferred? 

i.e. treatment-refractory PV, prior to progression to PMF or AML

Concordant low EPO level and bone marrow with megakaryocyte hyperplasia

e.g. IS < 0.002% by qPCR

Does VAF <1% make you want to do a BM biopsy for confirmation?

Would the presence of JAK2 versus CALR versus MPL influence this decision? What if there are other risk factors for cardiovascular disease?

This is in the setting of a patient who is now on ruxolitinib with rising leukocytosis and thrombocytosis, but cannot be on aspirin due to recent blee...

Aside from addressing the underlying case, is there a role for phlebotomy in secondary polycythemia such as in COPD or post-renal transplant erythrocy...

What if there are no cardiovascular risk factors?  Are VKAs preferred or can DOACs be used?

Is leukocytosis and thrombocytosis alone an indication for treatment?

Do you ever recheck JAK2/CALR/MPL/BCR-ABL? Would you recommend a bone marrow biopsy? Is cytoreductive therapy indicated?

Is there a role for aspirin or hydroxyurea? Do you perform phlebotomy, and if so, what goals?

Would you get bone marrow biopsy periodically? Would your approach change based off specific age or platelet count?  

Is this a reason to start hydrea? Would you give oral iron after adequate control on hydrea?

Would this change with someone who has a history of thrombosis (e.g. DVT/PE, MI, CVA)? Would this change with someone who is more fit vs more frail?

Do you recommend therapeutic phlebotomy to a certain Hct goal? Any strong evidence for thromboembolic risk related to erythrocytosis or if this is mit...

For example, a patient on cytoreductive therapy and aspirin BID, but suffers an arterial event, or a patient who is already on therapeutic anticoagula...

Individuals with MPNs may be at higher risk for thrombosis and be placed on antiplatelet therapy or even anticoagulation because of prior thrombosis. ...

Would you modify the radiation dose or field in this setting? Would you pre-emptively dose reduce chemotherapy, or modify the dosing of ruxolitinib?

In patients who are intolerant to hydroxyurea, anagrelide and interferon

Does the anagrelide shortage play a role in your decision-making? Do you avoid anagrelide in general?

In a patient with no evidence of bleeding, do you use a platelet cutoff? Do you utilize genomic testing (eg CALR, MPL, JAK2, etc.) to decide on cytore...

For instance, does isolated CALR mutated MF change your management?