phosphorus-radioisotopes and Thrombocythemia--Essential

Polycythemia vera, essential thrombocythemia, and primary myleofibrosis are chronic myeloproliferative neoplasms (MPNs) associated with an increased morbidity and mortality. MPNs are also associated with progression to acute myeloid leukemia (AML) or myelodysplastic syndromes (MDS). The "true" rate of transformation is not known mainly due to selection bias in clinical trials and underreporting in population-based studies. The outcome after transformation is dismal. The underlying mechanisms of transformation are incompletely understood and in part remain an area of controversy. There is an intrinsic propensity in MPNs to progress to AML/MDS, the magnitude of which is not fully known, supporting a role for nontreatment-related factors. High doses of alkylating agents, P(32) and combined cytoreductive treatments undoubtedly increase the risk of transformation. The potential leukemogenic role of hydroxyurea has been a matter of debate due to difficulties in performing large prospective randomized trials addressing this issue. The main focus of this review is to elucidate therapy-related leukemic transformation in MPNs with a special focus on the role of hydroxyurea.

Topics: Antineoplastic Agents; Cell Transformation, Neoplastic; Disease Progression; Humans; Hydroxyurea; Janus Kinase 2; Leukemia, Myeloid, Acute; Mutation; Myelodysplastic Syndromes; Phosphorus Radioisotopes; Polycythemia Vera; Primary Myelofibrosis; Survival Analysis; Thrombocythemia, Essential

Headache is frequently reported as one of the neurological manifestations of essential thrombocythaemia (ET) and other myeloproliferative neoplasms. It is associated with considerable morbidity; yet, it is a frequently under-recognised symptom. In patients with ET, headaches may be attributable to the disease, to the prescribed ET treatment, or unrelated to ET. The majority of headaches in ET are self-limiting and can be managed with standard headache therapies such as paracetamol, but it is vital that the clinician managing these conditions is able to recognise the headaches with a more sinister pathology. In this article, we will review the incidence and management of headaches in ET, whether they are primarily related to the disease or a result of its treatment. Identification of specific headache types in patients with ET may enable physicians to employ the most effective headache medication. This would enhance the patient-physician relationship, increasing patient compliance and thus reducing the risk of adverse outcomes.

Topics: Alkylating Agents; Analgesics; Anti-Inflammatory Agents, Non-Steroidal; Aspirin; Headache Disorders; Humans; Hydroxyurea; Immunologic Factors; Interferon-alpha; Phosphorus Radioisotopes; Platelet Aggregation Inhibitors; Quinazolines; Radiopharmaceuticals; Risk Factors; Thrombocythemia, Essential

Hydroxyurea is an old drug that is often used to control essential thrombocythemia and polycythemia vera in patients with high-risk disease. It is usually well tolerated and cheap and has been proven effective in many studies for the prevention of thrombohemorrhagic complications associated with these disorders. However, many clinicians are reluctant to use it because of the perceived risk of progression to acute leukemia. Several recent, large studies have given this drug a new lease on life. Relevant results from these studies are discussed, and the risk of leukemia is placed in perspective to demonstrate that hydroxyurea remains the drug of choice in patients with either of these disorders.

Topics: Aged; Agranulocytosis; Alkylating Agents; Clinical Trials as Topic; Combined Modality Therapy; Disease Progression; Evidence-Based Medicine; Hemorrhage; Humans; Hydroxyurea; Leukemia, Myeloid, Acute; Middle Aged; Phlebotomy; Phosphorus Radioisotopes; Polycythemia Vera; Thrombocythemia, Essential; Thrombophilia

We describe the periconception circumstances and outcome of 43 consecutive pregnancies in an unselected group of young women with essential thrombocythemia (ET).. We retrospectively studied 74 consecutive cases of young women with ET seen at our institution, among whom 43 pregnancies occurred in 20 patients.. Of the 43 pregnancies, 22 (51%) were successful (21 term and 1 preterm live births) and 21 (49%) ended in miscarriages (1 ectopic pregnancy, 2 elective abortions, 16 first-trimester spontaneous abortions, 1 stillbirth at 22 wk, and 1 abruptio placentae at 33 wk). Management of ET at the time of conception included either no specific therapy (16 cases) or the use of aspirin alone (24 cases), a cytoreductive agent (2 cases), or heparin (1 case). There were no significant differences with respect to platelet count or the effect of treatment with aspirin, either at the time of conception or during the first trimester, among cases of successful pregnancies (22), all miscarriages (21), or first-trimester spontaneous abortions (16). The findings were similar when the analysis was restricted to only first-time pregnancies. In patients with multiple pregnancies, the outcome of a subsequent pregnancy was not predicted by the outcome of the first. In general, in successful cases the last two trimesters were mostly uneventful, with healthy offspring being reported in all cases.. Pregnant patients with ET have an increased risk of first-trimester abortion which is not predictable by preconception platelet count or aspirin therapy. In addition, our experience does not support the use of prophylactic platelet apheresis during delivery.

Topics: Abortion, Induced; Abortion, Spontaneous; Abruptio Placentae; Adult; Anticoagulants; Aspirin; Busulfan; Erythromelalgia; Female; Fetal Death; Follow-Up Studies; Heparin; Humans; Hydroxyurea; Migraine Disorders; Obstetric Labor, Premature; Phosphorus Radioisotopes; Platelet Aggregation Inhibitors; Platelet Count; Plateletpheresis; Pregnancy; Pregnancy Complications, Hematologic; Pregnancy Outcome; Pregnancy Trimester, First; Pregnancy, Ectopic; Pregnancy, High-Risk; Quinazolines; Retrospective Studies; Risk; Thrombocythemia, Essential; Uterine Hemorrhage

The use of radioactive phosphorus (32P) to treat the myeloproliferative disorders (chronic leukemia, polycythemia vera and essential thrombocythemia) began in 1939 when John H. Lawrence treated the first patient on the basis of work done in the laboratory animals that found localization of the radioisotope in the spleen, liver, bone and in leukemic cells sufficient to indicate a therapeutic potential. After World War II when 32P became widely available, it was used extensively to treat the chronic leukemias and polycythemia vera. Its use in the treatment of essential thrombocythemia began later in 1950. Today it is not widely used in the treatment of the chronic leukemia, if at all, its use in polycythemia vera appears to have decreased substantially and replaced by hydroxyurea, and its use in the management of essential thrombocythemia is not widespread. In each instance it has been replaced by a drug developed for use in cancer chemotherapy, and in some instances by interferon. It probably has wider use in polycythemia vera in the rest of Western Europe than in the UK, and there are cogent reasons to suggest that it may be the best tool for the treatment of polycythemia vera. Thus have we discarded a treatment modality that in polycythemia vera may be the best?

Topics: Adult; Aged; Alkylating Agents; Chlorambucil; Clinical Trials as Topic; Combined Modality Therapy; Drug Utilization; Humans; Hydroxyurea; Immunologic Factors; Interferons; Leukemia; Leukemia, Lymphocytic, Chronic, B-Cell; Leukemia, Myelogenous, Chronic, BCR-ABL Positive; Middle Aged; Myeloproliferative Disorders; Phlebotomy; Phosphorus Radioisotopes; Polycythemia Vera; Radiotherapy; Thrombocythemia, Essential

The clinical course in both polycythaemia vera (PV) and essential thrombocythaemia (ET) is characterized by significant thrombohaemorrhagic complications and variable risk of disease transformation into myeloid metaplasia with myelofibrosis or acute myeloid leukaemia. Randomized studies have shown that the risk of thrombosis was significantly reduced in ET with the use of hydroxyurea (HU) and in PV with the use of chlorambucil or 32P. However, the use of chlorambucil or 32P has been associated with an increased risk of leukaemic transformation. Subsequently, other studies have suggested that both HU and pipobroman may be less leukaemogenic and as effective as chlorambucil and 32P for preventing thrombosis in PV. However, the results from these prospective studies have raised concern that even HU and pipobroman may be associated with excess leukaemic events in both ET and PV. The recent introduction of anagrelide as a specific platelet-lowering agent, the demonstration of treatment efficacy with interferon-alpha, and the revived interest in using low-dose acetylsalicylic acid provide the opportunity to initiate prospective randomized studies incorporating these treatments.

Topics: Adult; Aged; Aspirin; Chlorambucil; Disease Progression; Female; Hemorrhage; Humans; Hydroxyurea; Interferon-alpha; Leukemia, Myeloid; Leukemia, Radiation-Induced; Male; Middle Aged; Phlebotomy; Phosphorus Radioisotopes; Pipobroman; Polycythemia Vera; Primary Myelofibrosis; Prospective Studies; Quinazolines; Thrombocythemia, Essential; Thrombosis

Topics: Adult; Antineoplastic Agents; Busulfan; Follow-Up Studies; Hemorrhage; Humans; Hydroxyurea; Immunologic Factors; Interferon-alpha; Leukemia; Middle Aged; Phosphorus Radioisotopes; Plateletpheresis; Polycythemia Vera; Risk Factors; Thrombocythemia, Essential; Thrombosis

Topics: Bone Marrow; Busulfan; Diagnosis, Differential; Erythropoiesis; Granulocytes; Humans; Leukemia, Myeloid; Leukemia, Myeloid, Acute; Osteosclerosis; Phosphorus Radioisotopes; Polycythemia; Polycythemia Vera; Primary Myelofibrosis; Thrombocythemia, Essential

Thirty-one patients with essential thrombocythemia were randomized to receive either melphalan or radioactive phosphorus as myelosuppressive therapy. Twenty-seven patients were evaluable for response. Of 13 patients treated with melphalan, 11 had a complete response (platelet count less than 450,000/mm3) at 3 and 6 months. This response rate was significantly better than the response to radioactive phosphorus. The response rates were similar at 12 months. No significant toxicity was observed with either regimen.

Topics: Aged; Clinical Trials as Topic; Female; Follow-Up Studies; Humans; Male; Melphalan; Middle Aged; Myeloproliferative Disorders; Phosphorus Radioisotopes; Polycythemia Vera; Thrombocythemia, Essential

Patients with myeloproliferative neoplasms (MPNs), including polycythemia vera, essential thrombocythemia, and primary myelofibrosis, have a propensity to develop acute myeloid leukemia (AML) and myelodysplastic syndromes (MDSs). Using population-based data from Sweden, we assessed the role of MPN treatment and subsequent AML/MDS risk with special focus on the leukemogenic potential of hydroxyurea (HU).. On the basis of a nationwide MPN cohort (N = 11,039), we conducted a nested case-control study, including 162 patients (153 and nine with subsequent AML and MDS diagnosis, respectively) and 242 matched controls. We obtained clinical and MPN treatment data for all patients. Using logistic regression, we calculated odds ratios (ORs) as measures of AML/MDS risk.. Forty-one (25%) of 162 patients with MPNs with AML/MDS development were never exposed to alkylating agents, radioactive phosphorous (P(32)), or HU. Compared with patients with who were not exposed to HU, the ORs for 1 to 499 g, 500 to 999 g, more than 1,000 g of HU were 1.5 (95% CI, 0.6 to 2.4), 1.4 (95% CI, 0.6 to 3.4), and 1.3 (95% CI, 0.5 to 3.3), respectively, for AML/MDS development (not significant). Patients with MPNs who received P(32) greater than 1,000 MBq and alkylators greater than 1 g had a 4.6-fold (95% CI, 2.1 to 9.8; P = .002) and 3.4-fold (95% CI, 1.1 to 10.6; P = .015) increased risk of AML/MDS, respectively. Patients receiving two or more cytoreductive treatments had a 2.9-fold (95% CI, 1.4 to 5.9) increased risk of transformation.. The risk of AML/MDS development after MPN diagnosis was significantly associated with high exposures of P(32) and alkylators but not with HU treatment. Twenty-five percent of patients with MPNs who developed AML/MDS were not exposed to cytotoxic therapy, supporting a major role for nontreatment-related factors.

Topics: Adult; Aged; Antineoplastic Agents, Alkylating; Case-Control Studies; Female; Humans; Leukemia, Myeloid, Acute; Leukocyte Count; Logistic Models; Male; Middle Aged; Myelodysplastic Syndromes; Phosphorus Radioisotopes; Polycythemia Vera; Primary Myelofibrosis; Risk Factors; Thrombocythemia, Essential

(32)P phosphate was the first therapeutic radioisotope, used in leukaemia about 70 years ago. Since then, many new agents for haematological proliferations have been introduced successfully. Today there remains a distinct subgroup of elderly patients with polycythaemia vera and essential thrombocythaemia for whom (32)P is the most optimal treatment option, an assertion supported by two large studies with long follow-up.. The purpose of this guideline is to assist the nuclear medicine physician in treating and managing patients who may be candidates for (32)P phosphate therapy.

Topics: Adult; Female; Guidelines as Topic; Humans; Male; Middle Aged; Myeloproliferative Disorders; Phosphorus Radioisotopes; Quality Control; Radiometry; Radiopharmaceuticals; Radiotherapy; Thrombocythemia, Essential

We present a case of an 85-year-old woman with medically refractory essential thrombocythemia and subsequent venous thrombosis. She received conservative phosphorus-32 sodium phosphate therapy for 3 mCi, approximately half the usual dose. One month later, she received a second intravenous phosphorus-32 treatment of 3.5 mCi. She responded successfully to both treatments with drops in her platelet count and experienced no adverse effects. Our case is noteworthy in the effectiveness from a conservative dose while avoiding hematologic complications.

Topics: Aged, 80 and over; Blood Platelets; Drug Administration Schedule; Female; Humans; Phosphorus Radioisotopes; Platelet Count; Radiopharmaceuticals; Thrombocythemia, Essential; Treatment Outcome

Topics: Europe; Humans; Myeloproliferative Disorders; Nuclear Medicine; Patient Selection; Phosphorus Radioisotopes; Polycythemia Vera; Radiopharmaceuticals; Radiotherapy; Societies, Medical; Thrombocythemia, Essential; Treatment Failure; Treatment Outcome

A significant proportion of patients with Essential Thrombocythaemia (ET) have thrombotic complications which have an important impact upon the quality, and duration of their life. We performed a retrospective cross sectional study of the prevalence of antiphospholipid antibodies (APA) in 68 ET patients. Compared to 200 "elderly" controls (>50 years) there was a significant increase in anticardiolipin IgM (p < 0.0001) and anti beta2 glycoprotein I (anti-beta2GPI) IgM (p < 0.0001) antibodies in ET. Thrombosis occurred in 10/20 with APA and 12/48 without, p = 0.04, relative risk 2.0 (95% confidence intervals 1.03-3.86): these patients did not differ in terms of other clinical features. The prevalence of thrombosis in patients with dual APA (6/7) was significant when compared to those with single APA (p = 0.02) and the remaining patients (p < 0.0002). Also anti-beta2GP1 IgM antibodies either alone, or in combination with another APA, were associated with thrombosis (p = 0.02). These results suggest that the prevalence of APA in ET and their influence upon thrombotic risk merit investigation in a larger study.

Topics: Adult; Aged; Aged, 80 and over; Alkylating Agents; Antibodies, Anticardiolipin; Antibodies, Antiphospholipid; Antibody Specificity; Antiphospholipid Syndrome; Autoantigens; Autoimmune Diseases; beta 2-Glycoprotein I; beta 2-Microglobulin; Child; Clone Cells; Cross-Sectional Studies; Female; Glycoproteins; Humans; Immunoglobulin G; Immunoglobulin M; Interferon-alpha; Male; Middle Aged; Phosphorus Radioisotopes; Platelet Aggregation Inhibitors; Prevalence; Retrospective Studies; Thrombocythemia, Essential; Thrombophilia; Thrombosis

Blastic transformation of essential thrombocythemia (ET) preceded by chemotherapy is occasionally described in the literature. In ET as well as in other myeloproliferative disorders the leukemogenic effect of alkylating agents and (32)P is well established, and recent reports also indicate a certain leukemogenic effect of hydroxyurea in these disorders. However, leukemic transformation in untreated ET seems to be a rare event. This is probably due to the fact that, at some time during their clinical course, most ET patients receive chemotherapy and are thereby exposed to leukemogenic challenge. We report on a woman with ET who had not received cytoreductive treatment prior to the development of acute myeloid leukemia, indicating that this transformation was a natural progression of her disorder.

Topics: Acute Disease; Aged; Alkylating Agents; Female; Humans; Leukemia, Myeloid; Lymphocyte Activation; Phosphorus Radioisotopes; Thrombocythemia, Essential

Essential thrombocythemia (ET) is a chronic myeloproliferative disorder characterized by increased risk of thrombosis and/or hemorrhages. Cytotoxic drugs are mostly used in patients at high risk for thrombotic complications, while their use is still debated in low risk patients because of the risk of leukemia or secondary neoplasm. We discuss the leukemic risk of available treatment strategies in a large cohort of patients. Over a 12 years period we treated 23 patients with busulfan (BU), 1 with pipobroman (Pi), 6 with 32P, 48 with hydroxyurea (HU) in 62 cases associated with acetyl salicylic acid (ASA) while 77 patients received ASA alone and 33 did not receive any therapy. We observed 2 cases of acute leukemia (AL) and 1 of myelodysplastic syndrome (MDS). One of these patients had been treated with 32P and Pi these after with and the other two with BU and HU. They represented 23% of all patients treated with more than 1 cytotoxic agent, 16.6% of 32P treated subjects, 4% of those with HU and 6.4% of those with BU. The case of MDS occurred in a 81 years old female and represents 4% of cases of ET over the 70 years of age. No cases of AL or MDS were observed in patients not receiving cytotoxic therapy (with or without ASA). According to our experience the use of more than one cytotoxic agent in ET confirms the increase in the risk of leukemia in these cases. However, none of the patients treated with HU alone, even for more than 10 years (12 cases) developed AL. No treatment or therapy with ASA alone may be the best choice in young patients with ET with a low risk of thrombotic complications.

Topics: Aged; Aged, 80 and over; Antibiotics, Antineoplastic; Busulfan; Fatal Outcome; Female; Humans; Hydroxyurea; Leukemia; Male; Middle Aged; Myelodysplastic Syndromes; Neoplasms, Second Primary; Phosphorus Radioisotopes; Pipobroman; Thrombocythemia, Essential

Topics: Adult; Aged; Aged, 80 and over; Antineoplastic Agents; Busulfan; Female; Follow-Up Studies; Humans; Hydroxyurea; Leukemia, Myeloid, Acute; Leukemia, Myelomonocytic, Chronic; Male; Middle Aged; Myelodysplastic Syndromes; Neoplasms, Second Primary; Phosphorus Radioisotopes; Pipobroman; Retrospective Studies; Thrombocythemia, Essential

259 patients with primary proliferative polycythaemia (PPP) and idiopathic thrombocythaemia (IT) have been treated with 32P over the last 15 years. Complete follow-up data were obtained in 238 patients. PPP was the diagnosis in 183 patients and 76 patients had IT. The sex ratio in PPP was male/female 1.1:1 and in IT 1:1.4. Patients' ages ranged from 28 to 95 years (median 72 years). The number of 32P administrations per patient ranged from 1 to 13 (median 2) and the total administered activity per patient ranged from 81.4 to 4162 MBq (median 496 MBq). The outcome showed a normalization of the full blood count in 50% of patients after a single administration of 32P and in 73% after two treatments. 13 patients (5.5%) developed myelofibrosis; 18 (7.6%) developed leukaemia while other cancers arose in 19 patients (8%). 32P therapy proved to be of particular value in the elderly. 32P is easy to administer and is cost effective, compared with the alternative of chemotherapy where good compliance and frequent hospital visits are required.

Topics: Adult; Aged; Aged, 80 and over; Female; Follow-Up Studies; Humans; Incidence; Male; Middle Aged; Neoplasms, Radiation-Induced; Phosphorus Radioisotopes; Polycythemia Vera; Retrospective Studies; Thrombocythemia, Essential; Treatment Outcome

In polycythemia vera (PV), treatment with chlorambucil and radioactive phosphorus (p32) increases the risk of leukemic transformation from 1% to 13-14%. This risk has been estimated to be 1-5.9% with hydroxyurea (HU) therapy. When compared with historical controls, the risk with use of HU does not appear to be statistically significant. The leukemogenic risk of HU therapy in essential thrombocytosis (ET) and in myelofibrosis with myeloid metaplasia (MMM) is unknown. HU remains the main myelotoxic agent in the treatment of PV, ET, and MMM. We studied 64 patients with these three disorders, seen at our institution during 1993-1995. The patients were studied for their clinical characteristics at diagnosis, therapies received, and development of myelodysplasia or acute leukemia (MDS/AL). Forty-two had PV, 15 ET, and 6 MMM, and 1 had an unclassified myeloproliferative disorder. Of the 42 patients with PV, 18 were treated with phlebotomy alone, 16 with HU alone, 2 with p32, 2 with multiple myelotoxic agents, and 2 with interferon-alpha (IFN-alpha). Two patients from the phlebotomy-treated group, one from the HU-treated group, and 1 from the multiple myelotoxic agent-treated group developed MDS/AL. In the larger group, 11 received no treatment or aspirin alone, 18 were treated with phlebotomy alone, 25 with HU, 5 with multiple myelotoxic agents, 2 with p32, 2 with IFN-alpha, and 1 with melphalan. Study of the entire group of 64 patients showed that only one additional patient (total of 5 out of 64) developed MDS/AL. This patient had been treated with HU alone. Statistical analysis did not show any association between clinical characteristics at diagnosis, or HU therapy, and development of MDS/AL (P=0.5). Thus, our data provide no evidence suggestive of increased risk of transformation to MDS/AL with HU therapy in PV, ET, and MMM. Larger, prospective studies are needed to study this issue further.

Topics: Acute Disease; Anemia, Refractory, with Excess of Blasts; Busulfan; Cell Transformation, Neoplastic; Chlorambucil; Cohort Studies; Disease Progression; Drug Therapy, Combination; Enzyme Inhibitors; Female; Humans; Hydroxyurea; Incidence; Interferon-alpha; Leukemia; Leukemia, Radiation-Induced; Male; Melphalan; Middle Aged; Phlebotomy; Phosphorus Radioisotopes; Polycythemia Vera; Preleukemia; Primary Myelofibrosis; Retrospective Studies; Ribonucleotide Reductases; Risk; Thrombocythemia, Essential

Myeloproliferative disorders (MPD) are prone to modification and evolution during the progression of the disease. While post-polycythemia myeloid metaplasia and chronic myelogenous leukemia following polycythemia vera have been frequently described, no report is available about the evolution of polycythemia vera into essential thrombocythemia. Our case is probably the first report on this occurrence. In the course of a fortuitous observation of electrocardiographic alterations, a diagnosis of polycythemia vera was ruled out in accordance with polycythemia vera study group criteria. At the time of diagnosis, RBC was 6 x 10(12)/L, WBC 15 x 10(9)/L, Ht 59% and platelets 1000 x 10(9)/L. The patient was treated with phlebotomies and radioactive phosphorus achieving a good remission or the disease. Five years later, platelets rose to over 3300 x 10(9)/L without significant modification or RBC, WBC and Ht. The restaging or the disease was consistent for an essential thrombocythemia. In particular, RBC mass was within normal levels. During the last ten years, the patient has been followed recurrently and the blood picture remained stationary, without an increase in the hematocrit but with a platelet count between 658 and 800 x 10(9)/L. We conclude that this report may complete data concerning the evolution of MPD in others.

Topics: Aged; Aged, 80 and over; Alkylating Agents; Busulfan; Hematocrit; Humans; Leukocyte Count; Male; Phosphorus Radioisotopes; Platelet Count; Polycythemia Vera; Thrombocythemia, Essential; Time Factors

A short survey of essential thrombocythaemia is made and some diagnostic and therapeutic aspects of the disease and personal clinical experience are discussed.

Topics: Alkylating Agents; Antimetabolites; Aspirin; Bone Marrow; Dipyridamole; Drug Therapy, Combination; Humans; Phosphorus Radioisotopes; Platelet Count; Remission Induction; Thrombocythemia, Essential

Between March 1970 and February 1987, radiophosphorus (32P) was used to treat bone marrow disorders in 6 dogs; 4 had polycythemia vera and 2 had essential thrombocythemia. Activities of 32P given initially ranged from 2.4 to 3.3 mCi/m2. Four dogs responded well to 32P treatment, with gradual resolution of high RBC or platelet counts. Two of these dogs died of intercurrent disease unrelated to their bone marrow disorder, before blood counts could be stabilized. Two dogs did not respond to the initial 32P treatment nor to additional treatments with 32P, and had clinical signs and blood counts stabilized by use of phlebotomy or chemotherapeutic agents. We reviewed and analyzed 5 other cases of bone marrow disorders in dogs treated with 32P and included the findings from their records with the records of our 6 dogs in this retrospective analysis. Of the 8 dogs with polycythemia vera treated with 32P, 5 were given a single treatment that controlled clinical signs and blood counts for the remainder of the follow-up period. Of the 3 dogs treated for thrombocytosis with 32P, 2 had blood counts that responded to a single treatment.

Topics: Animals; Dog Diseases; Dogs; Female; Male; Phosphorus Radioisotopes; Polycythemia Vera; Retrospective Studies; Thrombocythemia, Essential

The major complications of essential thrombocythaemia include haemorrhage and thrombosis, events which are related to the level of the abnormal platelet count. We report here on the use of radioactive phosphorus (32P) in eight patients with essential thrombocythaemia. Two patients required multiple injections of 32P to control platelet count, and there was no reduction in the rate of fall of platelets with each injection. Three patients required chemotherapy for persistent thrombocythaemia despite multiple doses of 32P. No clinical or haematological characteristics could be identified for those patients whose disease was difficult to control. Radioactive phosphorus is a safe and effective method to control platelet counts in patients with essential thrombocythaemia.

Topics: Adult; Aged; Female; Humans; Male; Middle Aged; Phosphorus Radioisotopes; Platelet Count; Thrombocythemia, Essential

We report on a follow up in 23 patients with primary thrombocytosis treated with two different doses of 32phosphorus phosphate (32P). Ten patients with essential thrombocytosis (ET) received 2 mCi and 13 patients with polycythemia vera (PV) received the standard dose of 0.1 mCi/kg b.w. The patients were listed as having a complete response (CR), partial response (PR) or no response (NR) considering platelet count at 3 and 12 months after 32P injection. The results indicate the existence of a clear correlation of the rate of remission with the 32P injected dose. PV patients show, in fact, a percentage of complete remission higher than ET patients. However, the use of higher doses induces more early and long-term complications.

Topics: Adult; Female; Follow-Up Studies; Humans; Male; Middle Aged; Phosphorus Radioisotopes; Platelet Count; Polycythemia Vera; Thrombocythemia, Essential; Thrombocytosis

Topics: Aged; Humans; Leukemia, Myeloid, Acute; Male; Phosphorus Radioisotopes; Thrombocythemia, Essential

The various myeloproliferative diseases have different symptoms, therapeutic problems, and prognoses. The most common of these disorders appears to be agnogenic myeloid metaplasia, which primarily affects older persons. The five-year survival rate at the Mayo Clinic for these patients is 58%, and the prognosis depends on the presence of symptoms, anemia, and thrombocytopenia and on the size of the liver. Androgen therapy is often necessary to control anemia, and splenectomy may be indicated.

Topics: Adult; Aged; Chlorambucil; Female; Humans; Male; Melphalan; Middle Aged; Myeloproliferative Disorders; Phosphorus Radioisotopes; Polycythemia Vera; Primary Myelofibrosis; Thrombocythemia, Essential

Six patients are described in whom gangrene of one or more toes occurred as the presenting feature of essential thrombocythaemia. Spontaneous platelet aggregation was observed in platelet-rich plasma from four patients and platelet aggregation after the addition of adenosine diphosphate and collagen was highly abnormal in samples from all six. All of the patients described dramatic relief of pain within six hours of ingestion of aspirin and this coincided with disappearance of the spontaneous platelet aggregation and collagen-induced platelet aggregation. Treatment with phosphorus-32 corrected the platelet count and there were no further recurrences of peripheral vascular disease. Platelet function tests performed at the time all gave normal results. It is concluded that essential thrombocythaemia is an important and treatable cause of peripheral vascular disease.

Topics: Adenosine Diphosphate; Adult; Aspirin; Blood Cell Count; Collagen; Gangrene; Humans; Male; Middle Aged; Phosphorus Radioisotopes; Platelet Aggregation; Thrombocythemia, Essential; Toes

Topics: Blood Platelets; Humans; Phosphorus; Phosphorus Radioisotopes; Phosphorus, Dietary; Radioactivity; Thrombocythemia, Essential

Topics: Blood Platelets; Hemorrhagic Disorders; Phosphorus; Phosphorus Radioisotopes; Phosphorus, Dietary; Radioactivity; Thrombocythemia, Essential