Additional treatments

Several types of drugs can be given to address common problems.

There are a number of different treatments used in addition to the principal drugs used to treat myeloproliferative neoplasms (MPNS). Your haematologist may prescribe additional treatments to prevent or control side effects. If you have myelofibrosis  (MF) you may be prescribed additional medications. You can read more about these treatments by clicking on the links below.

Erythropoetin (EPO)

EPO is a hormone given in MF to stimulate red cell production. Sometimes anaemia is the main problem for MF patients. If this is the case, treatment with erythropoetin (EPO) can be effective. EPO is the hormonenaturally produced by the body that stimulates the bone marrow to make red cells. This drug is given by injection under the skin. EPO injections can cause fever, bone pain and sometimes spleen enlargement.

Azacitidine

Azacytidine is a drug usually used to treat leukaemia and advanced stages of a related condition called myelodysplasia. It has also been used for patients with aggressive stages of MPN where the condition is close to leukaemia. This drug is given by injection under the skin every day for the first 7 of every 28 days. It needs to be given in hospital. The benefit of azacytidine is to slow progression of the disease (but not cure), control blood counts and sometimes improve haemoglobin. Azacytidine can cause several side effects where it is injected, low blood counts with risks of bleeding and infection as well as constipation, headaches and dizziness.

Zoledronic acid

Zolendronic acid belongs to a group of drugs known as bisphosphonates they help to regulate the turnover and remodeling of bone. They are sometimes used in MPN to control bone pain. Zoledronic acid in particular is given by an infusion direct into the vein like a blood transfusion usually every 4 weeks. It can effect calcium levels in the body and kidney function so these things are monitored during treatment. An important side effect of these drugs is a painful problem after dental work caused osteonecrosis. Before taking these drugs its important to think about how much dental treatment you might need and always to warn your dentist if you have ever taken them as the side effect persists after you stop the drug.

Transfusion

People with MF may be given blood transfusions. If your blood cell counts are low, you may be given blood transfusions of red cells and platelets.

Each transfusion works for a certain amount of time: platelets last for a few days and red blood cells a few weeks, although the amount of time will vary from person to person depending on how low your count is, how quickly you make your own cells, how big your spleen is, whether you are bleeding, and other factors.

Blood is given in hospital usually on a day ward. All blood in the UK is produced and sent to hospitals by the National Blood Service. Their website provides interesting facts about blood how it is collected and the risks and history of blood transfusion.

Gout and MPNs

Gout is a painful condition caused by uric acid crystals in your body building up in one or more joints and causing pain and inflammation. Gout is a side effect of MPNs. It’s also unfortunately a side effect of many treatments used to treat MPNs, including hydroxycarbamide, anagrelide and interferon treatment. Allopurinol is a drug that is used to prevent the development of gout.

Controlling gout

This painful condition can be controlled in several ways:

  • Reducing the number of red cells in your bloodstream will also reduce gout
  • If you have an acute attack of gout, you will probably need painkillers to reduce the pain you are feeling
  • Drinking large quantities of water can also help prevent gout
  • Other drugs may be prescribed as well
Your haematologist may sometimes prescribe allopurinol as a premedication for patients who are just starting therapies for their MPN. They may then stop taking allopurinol as their blood counts normalise. Patients who have had gout, and in particular more than one episode, often take this medication over the long term.

Side effects of allupurinol

Allopurinol often causes side effects of skin rash and a metallic taste in your mouth.