What question did this study set out to answer?

This study aims to evaluate the real-world burden of phlebotomy and treatment gaps in patients with polycythemia vera across different clinical settings.

May 30, 2026

Real-world phlebotomy (PHL) burden and treatment gaps in US patients with polycythemia vera: A chart review across physician practice settings.

Key Points

This study aims to evaluate the real-world burden of phlebotomy and treatment gaps in patients with polycythemia vera across different clinical settings.
Retrospective chart review of patients diagnosed with polycythemia vera between 8/2020-7/2023
Data abstracted from de-identified records across community, academic, and mixed practice settings
Assessment included utilization rates, interruptions, tolerability, and incidence of iron deficiency
Phlebotomy was utilized by 71% of the 128 patients; most had a planned frequency of every 4 weeks
18% experienced interruptions, primarily due to hematologic reasons; 34% discontinued for various factors
Iron deficiency occurred in 17% of patients, with fatigue reported in 93% of those affected

Abstract

e18588 Background: Guideline-aligned PV management targets hematocrit (HCT) <45% using PHL and/or cytoreductive therapy, whereas PHL is often used as first-line treatment. Given implementation and PHL burden may vary by clinical setting, this study assessed PHL utilization, interruptions/discontinuations, tolerability, and iron deficiency (ID), overall and by practice setting. Methods: A retrospective chart review abstracted de-identified records of PV patients (≥ 18 years) first diagnosed between 8/2020-7/2023, with ≥ 24 months of follow-up unless deceased. Hematologists/oncologists completed structured case report forms and reported clinical practice setting (community C, academic A, mixed M). PHL-related burden outcomes included utilization, interruptions/discontinuations with reasons, tolerability, and ID. Poor PHL response/tolerance was defined as physician-documented failure to meet disease/hematologic criteria, procedure-related intolerance, or lack of symptomatic benefit. Hematologic reasons for PHL interruptions/discontinuations include anemia, ID, leukocytosis, thrombocytosis, inadequate HCT control. Results were summarized overall and by practice setting. Results: Among 128 patients with PV (median age 62 years; C: n=60, A: n=50, M: n=18; mean follow-up of 2.7 years), PHL was used in 71% (n=91), alone or with cytoreductive therapy. The most common planned administration frequency for PHL was every 4 weeks (45%; n=41) and planned HCT<45% target in 79% (n=72) (C: 86%, A: 76%). Mean PHL rate was 7.3 per patient-year during non-cytoreductive therapy period (C: 7.5, A: 8.1). PHL interruptions occurred in 18% (n=16) with the first one most often for hematologic reasons (56%). Among 34% (n=44) who discontinued PHL, reasons included hematologic reasons (41%), patient-centered factors (18%), and tolerability/limitations (18%). Poor PHL response/tolerance occurred in 29% (n=26) of PHL-treated patients; mean PHL duration before discontinuation among these patients was 294 days (C: 262, A: 296). After PHL discontinuation for poor response/tolerance, 50% started cytoreductive treatment (hydroxyurea 19%, ruxolitinib 19%, ropeginterferon alfa-2b 12%), and 50% had no further treatment observed. PHL-related ID occurred in 17% of PHL patients (C: 14%, A: 13%). Fatigue was noted in 93% of ID patients during the first ID episode. First ID episode management included pausing PHL (60%) and iron supplementation (40%). Conclusions: PHL remains widely used in routine PV care across clinical practice settings, with high reliance despite available cytoreductive therapy options. Substantial PHL burden and HCT control challenges were observed. These findings highlight a need for more effective, better-tolerated treatments that reduce PHL reliance, achieve and maintain HCT control and support consistent care across settings.

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