Current treatment practice for essential thrombocythaemia in adults

Posterior reversible encephalopathy syndrome with essential thrombocythemia: A case report

RATIONALE

Posterior reversible encephalopathy syndrome (PRES) is a rare neurological disease of the posterior subcortical white matter that manifests as headache, seizures, visual impairment, disturbance of consciousness, and changes in mental state. While PRES is associated with specific imaging findings involving the posterior circulation area of the brain. In the present study, we report the first case of PRES associated with essential thrombocythemia (ET).

PATIENT CONCERNS

A 49-year-old man suddenly experienced headache, followed by the gradual appearance of consciousness disorders and mental behavior abnormalities. Neurological tests showed that the patient had a Glasgow Coma Scale score of 12, normal muscle strength and tension of the limbs, and was negative for meningeal irritation.

DIAGNOSIS

Magnetic resonance imaging of the brain showed extensive vasogenic edema in the deep white matter of the right cerebellum and the left occipital and temporal lobes and a diagnosis of PRES was considered. Routine blood test showed that his platelet count was markedly increased, and the JAK2 V617F mutation analysis with allele-specific real-time polymerase chain reaction was positive. The bone marrow biopsy indicated an increasing number of megakaryocytes. These findings indicated ET.

INTERVENTIONS

PRES was treated with a dehydrating agent and supportive and symptomatic treatments. Aspirin tablets were prescribed to address the patient's ET.

OUTCOME

After treatment, the abnormal findings on head imaging were completely reversed. His neurological symptoms were completely relieved.

LESSONS

PRES may be correlated with ET; specifically, ET may trigger PRES and be a risk factor for the acute onset of neurological deficits.

Current treatment practices for essential thrombocythemia: survey results from European hematologists/oncologists

Physicians from nine European countries were asked to complete a survey, which was conducted in two waves (Wave II, October 2009; Wave III, May 2010), based on their current treatment practices for essential thrombocythemia (ET). The aim of the study was to gain insight into physicians' criteria for treatment initiation and reasons for switching from one therapy option to another. The majority of patients receiving first-line cytoreductive therapy for ET were treated with hydroxycarbamide (HC; 63 and 71% in Waves II and III, respectively), while the majority of patients on second-line therapy received anagrelide (51 and 60% in Waves II and III, respectively). Efficacy was the main factor cited for switching therapies (cited by 47 and 58% of physicians in Waves II and III, respectively). Further studies are needed to determine whether current practices used by physicians for the treatment of ET are consistent with consensus guidelines.