Some polycythemia vera (PV) patients have further disease progression despite treatment. After years of disease, several conditions may arise:
- Cells can undergo further changes and no longer overproduce red cells. For a time, the red cell count may stay near normal without treatment or drop below normal, resulting in anemia.
- The spleen may become further enlarged.
- Bone marrow may become fibrous or scarred, reducing its ability to make red cells and platelets, a condition called myelofibrosis.
- The platelet count may fall to low levels.
- Immature white cells may be released from the marrow into the blood.
Therapy at this time may include:
- blood transfusions as needed for anemia and pain control
- myelosuppressive drugs to control white cell and platelet counts or spleen size
- splenectomy (surgical removal of the spleen) for some cases of massive spleen enlargement
- low-dose radiation therapy to the spleen for patients unable to tolerate surgery