[Treatment of polycythemia. I--Using radiophosphorus with or without treatment in 483 patients over 65 years of age].
OBJECTIVE
To compare by a prospective study in high risk polycythemia vera (PV) patients 33P alone and 32P followed by low-dose hydroxyurea (HU) maintenance therapy. Toxicity, efficiency, and leukemogenic potential were studied.


METHODS
483 patients with a documented PV, aged more than 65 years at diagnosis, were included between 1980 and 1996 in a prospective study comparing 32P alone and 32P followed by low-dose HU maintenance therapy. Blood cell counts were performed every two months and a clinical evaluation by a specialist was obtained every four or six months.


RESULTS
Treatments were well tolerated, but chronic leg ulcers were observed in the maintenance therapy arm. The risk of leukemia was about 15% at the 15th year in the group of patients treated by 32P alone, but reached 30% in the group receiving maintenance therapy. In both arms, there was no significant correlation between occurrence of leukemia and the total dose of 32P. There was a correlation between the leukemic risk and disease severity, estimated on the frequency of relapse. Cancer occurrence was slightly higher than expected in the maintenance arm. HU treatment did not protect against progression to myelofibrosis, probably due to the lack of maintenance of an efficient myeloid or megakaryocytic suppression. Median life-span was slightly shorter in the group receiving HU maintenance. In all cases, life-span was only one year lower than that observed in the reference population.


CONCLUSIONS
For all these reasons, we suggest the us of 32P alone in elderly patients; complementary chemotherapy should only be prescribed in the cases with short-term relapse, and late resistance to 32P.
Najean
Y
Y
Service de Médecine Nucléaire, Hôpital Saint-Louis, 1 avenue Claude-Vellefaux, 75475 Paris.
Rain
J D
JD
Goguel
A
A
Grange
M J
MJ
Vigneron
N
N
Dupuy
E
E
Mougeot-Martin
M
M
D000368:Aged; D000369:Aged, 80 and over; D003131:Combined Modality Therapy; D005260:Female; D006801:Humans; D006918:Hydroxyurea / Q000009:adverse effects / Q000627:therapeutic use*; D007938:Leukemia / Q000209:etiology / Q000401:mortality; D008297:Male; D010761:Phosphorus Radioisotopes / Q000009:adverse effects / Q000627:therapeutic use*; D011087:Polycythemia Vera / Q000401:mortality / Q000628:therapy*; D011446:Prospective Studies; D012307:Risk Factors; D015996:Survival Rate
D010761:Phosphorus Radioisotopes; D006918:Hydroxyurea