Myeloproliferative Neoplasms (MPN)

Regimen Options

Last Updated: 06/03/2024 See Details

	Evolent Pathways	Febrile Neutropenic Risk	Emetogenic Risk	References
POLYCYTHEMIA VERA
Initial/Subsequent Therapy: Low & High-Risk	hydroxyurea	Low	Low	NCCN Guidelines® for Myeloproliferative Neoplasms V.1.2023. Barbui T et al. Leukemia . 2018 May;32(5):1057-1069.
ESSENTIAL THROMBOCYTHEMIA
Initial/Subsequent Therapy: High-risk	hydroxyurea	Low	Low	NCCN Guidelines® for Myeloproliferative Neoplasms V.1.2023. Barbui T et al. Leukemia . 2018 May;32(5):1057-1069.
	anagrelide	Low	Low	NCCN Guidelines® for Myeloproliferative Neoplasms V.1.2023. Mazzucconi MG et al. https://doi.org/10.1111/ejh.13454
	peginterferon alfa-2a (Pegasys) only if failed/intolerant to Hydroxyurea	Low	Low	NCCN Guidelines® for Myeloproliferative Neoplasms V.1.2023. Silver RT et al. Cancer . 2017 Jul 15;123(14):2680-2687.
MYELOFIBROSIS
Initial/Subsequent Therapy: Low-Risk	hydroxyurea	Low	Low	NCCN Guidelines® for Myeloproliferative Neoplasms V.1.2023. Barbui T et al. Leukemia . 2018 May;32(5):1057-1069.
	ruxolitinib	Low	Low	NCCN Guidelines® for Myeloproliferative Neoplasms V.1.2023. Harrison C et al. N Engl J Med 2012; 366:787-798
Initial/Subsequent Therapy: High-Risk	hydroxyurea	Low	Low	NCCN Guidelines® for Myeloproliferative Neoplasms V.1.2023. Harrison C et al. N Engl J Med 2012; 366:787-798
	ruxolitinib	Low	Low	NCCN Guidelines® for Myeloproliferative Neoplasms V.1.2023. Harrison C et al. N Engl J Med 2012; 366:787-798
	momelotinib (Initial therapy Hgb < 8; subsequent Hgb <10)	Low	Low	NCCN Guidelines® for Myeloproliferative Neoplasms V.1.2024. Verstovsek S et al. Lancet . 2023 Jan 28;401(10373):269-280.
	fedratinib if plt ≥50k	Low	High	NCCN Guidelines® for Myeloproliferative Neoplasms V.1.2023. Harrison CN et al. Lancet Haematol . 2017 Jul;4(7):e317-e324.
	pacritinib if plt <50K	Low	Low	NCCN Guidelines® for Myeloproliferative Neoplasms V.1.2023. Mesa RA et al. Lancet Haematol . 2017 May;4(5):e225-e236.

POLYCYTHEMIA VERA

Initial/Subsequent Therapy: Low & High-Risk

Evolent Pathways

hydroxyurea

Febrile Neutropenic Risk

low

Emetogenic Risk

low

References

ESSENTIAL THROMBOCYTHEMIA

Initial/Subsequent Therapy: High-risk

Evolent Pathways

hydroxyurea

Febrile Neutropenic Risk

low

Emetogenic Risk

low

References

Evolent Pathways

anagrelide

Febrile Neutropenic Risk

low

Emetogenic Risk

low

References

Evolent Pathways

peginterferon alfa-2a (Pegasys) only if failed/intolerant to Hydroxyurea

Febrile Neutropenic Risk

low

Emetogenic Risk

low

References

MYELOFIBROSIS

Initial/Subsequent Therapy: Low-Risk

Evolent Pathways

hydroxyurea

Febrile Neutropenic Risk

low

Emetogenic Risk

low

References

Evolent Pathways

ruxolitinib

Febrile Neutropenic Risk

low

Emetogenic Risk

low

References

Initial/Subsequent Therapy: High-Risk

Evolent Pathways

hydroxyurea

Febrile Neutropenic Risk

low

Emetogenic Risk

low

References

Evolent Pathways

ruxolitinib

Febrile Neutropenic Risk

low

Emetogenic Risk

low

References

Evolent Pathways

momelotinib (Initial therapy Hgb < 8; subsequent Hgb <10)

Febrile Neutropenic Risk

low

Emetogenic Risk

low

References

Evolent Pathways

fedratinib if plt ≥50k

Febrile Neutropenic Risk

low

Emetogenic Risk

high

References

Evolent Pathways

pacritinib if plt <50K

Febrile Neutropenic Risk

low

Emetogenic Risk

low

References

Pathways and Low-Value Regimens

Myeloproliferative Neoplasms (MPN)