The answer to your question depends on your treatment goals, risk tolerance, and how you respond to the treatment you try. At 1.8 million, you are a clear candidate for cytoreduction. You are at significant risk for bleeding events in addition to thrombosis.

Hydroxyurea (HU) is a faster acting drug that can more rapidly decrease platelet levels; however it is a highly toxic drug with a low therapeutic index. Some people can tolerate the drug but not all can. While there are clear benefits, there are also risks, in particular long-term risks associated with HU. HU is chemotherapy, a cytotoxin that works by inhibiting DNA activity.

Pegasys (PEG) is a slower acting drug that can decrease platelet levels while possibly reducing the risk of progression of the ET. Like all of our treatment options, there are risks associated with PEG. PEG is an immune modulating medication that may be disease modifying. .

While both medications are in common use for ET, HU and PEG are both used off-label. PEG is considerably more expensive than HU, so many formularies prefer it.

I was intolerant of and refractory to HU. I have done much better on the interferons (PEG and later Besremi). My response, however, does not predict yours.

Wishing you all the best.

I was on 500mg per day of hydroxcarbamide for 18 months and my platelets when down from 500 to 400. Owing to side effects I persuaded my Haematologist to give me 40micrograms per week of Pegasys and platelets went down to 270 within a month with almost no side effects. Changed to 50 micrograms every 10 days and now wait for next blood test to see the result

Hi Ricky,
You look pretty young, have a very high platelet count, and a CAL-R mutation I suggest you have a consult appointment with an MPN specialist.
Another site you can search on is healthunlocked.com. It is located in the United Kingdom and participants are worldwide.
I am 80 and have ET JAK2…I only have experience with Hydroxyurea.
Best wishes on your journey, Eileen

Hello Ricky. My numbers were 1.2 million and Was put on 1000 mg of Hydrea for weekdays and 500 mg for weekends. It took about 6 months but my numbers are around 500 now. I also have the cal-r mutation. I know some have bad side effects but I have min side effects. I hope this helps and wish the best to you.

@A myMPNteam Member to be exact pegasys is a interferon with a added peg molecule
this lets interferon get in your body at a slow paste
interferon you need normally to take 3 times a week pegasys only once

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