Table 5.

Common treatments for MPNs and nursing strategies to monitor/manage their associated side effects

Treatment	Which MPNs is it used in?	Why is it used?	What are the adverse events/key safety issues to consider?	How can we monitor for/manage these treatment-associated adverse events?
Low-dose ASA (81 mg/day)	ET and PV	Reduces the incidence of thrombosis, particularly if combined with HU	Increased risk of bleeding Risk of peptic ulceration	Educate patients about the risk of bleeding and peptic ulcers with ASA therapy Monitor platelet count during therapy: If < 50,000/m3, consider discontinuing ASA
Hydroxyurea (HU)	ET, PV, and MF (if symptomatic splenomegaly and thrombocytosis)	Reduces number of blood cells produced in the bone marrow by slowing cell division Effective at preventing thrombosis Generally used as first-line cytoreductive therapy in PV and ET	Mouth and leg ulcers Skin lesions Anemia Neutropenia Fever	Monitor for signs of leg or mouth ulcers and refer to physician if they occur as dose reductions or treatment discontinuation may be required
Interferon	ET and PV	Suppresses overproduction of blood cells produced in the bone marrow Generally reserved for 2nd or 3rd line treatment (unless patient is pregnant or of childbearing age – then may be used as first-line treatment)	Often significant and include: myelosuppression, infection depression flu-like symptoms blurred vision asthenia	Screen for depression/mental health issues or refer patient for psychiatric evaluation prior to initiating therapy
Anagrelide	ET	Potent and specific platelet-lowering activity Reduces platelet production by inhibiting megakaryocyte (MK) colony development	Headache Tachycardia May increase risk of hemorrhage if combined with ASA	Consider cardiac screening (heart rate, pulse, ECG) prior to and during treatment if patient is at high risk for CV events
Busulfan	ET, PV and MF	Alkylating agent that interferes with the production of blood cells May be appropriate as second-line agent	Nausea/vomiting Profound and prolonged cytopenias, especially thrombocytopenia	Consider initiating antiemetic prior to busulfan therapy Monitor platelet count
Phlebotomy	PV	Removal of blood during procedure is a simple method to reduce excess RBCs Renders patients iron deficient, limiting RBC production	Minimal but may include: local bruising fatigue feeling faint	Ensure patient has not fasted prior to procedure Ensure patient stays well hydrated following the procedure (saline may be required)
Ruxolitinib	PV and MF	Interferes with the JAK/ STAT pathway which regulates blood cell production and plays a key role in the underlying mechanism of PV and MF Approved treatment for: PV that has had inadequate response to or is intolerant of HU treatment of splenomegaly and/or its associated symptoms in MF	Anemia Thrombocytopenia Diarrhea Muscle spasms Dizziness Dyspnea	Consider shingles vaccine prior to treatment for patients >60 years Consider cardiac screening (heart rate, pulse, ECG) prior to and during treatment if patient is at high risk for CV events Consider TB skin testing prior to treatment in high-risk patients Monitor Hb and platelet count: If platelet count is <125,000/mm3 but >50,000/mm3 : dose reduction may be required If platelet count is <50,000/mm3 : treatment interruption is recommended until platelet count returns to normal

ET: essential thrombocythemia; PV: polycythemia vera; MF: myelofibrosis; CV: cardiovascular; HU: hydroxyurea; Hb: hemoglobin; ECG: electrocardiogram; RBCs: red blood cells; ASA: acetylsalicylic acid; TB: tuberculosis