Therapy Transition

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Initiating ruxolitinib in a patient with PV may require overlap of therapy at the beginning. Baseline CBC will help guide the need for continued hydroxyurea. In this case, the hydroxyurea dose was reduced to 500 mg once daily for 1 week to allow WBC to recover prior to starting ruxolitinib and the patient had just undergone phlebotomy. Baseline CBC results on ruxolitinib initiation were WBC 8700/µL with an absolute neutrophil count (ANC) of 6000/mm3, Hct 43%, and platelets 500,000/µL. Ruxolitinib starting dose for PV is 10 mg twice daily. This patient started ruxolitinib while continuing hydroxyurea 500 mg once daily for 1 more week; then hydroxyurea was discontinued. 

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To date, 3 months after ruxolitinib initiation, the patient has not required a phlebotomy and disease symptoms are controlled. Most recent CBC results include WBC 4500/µL, ANC 3000/mm3, Hct 42%, platelets 335,000/µL. 

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