Advantages of isovolemic large-volume erythrocytapheresis as a rapidly effective and long-lasting treatment modality for red blood cell depletion in patients with polycythemia vera.

Long-term survival of patients with polycythemia vera (PV) is essentially determined by the ability to reduce the risk of thromboembolic complications resulting from the altered rheological conditions by the high red blood cell (RBC) mass of these patients. RBC depletion to normal hematocrit (Hct) values is the first line therapy and should be preferred to chemotherapy (or P32) because of the long-term risk of acute leukemia or other secondary malignancies. RBC depletion is accomplished much more effectively and rapidly by erythrocytapheresis (EA) than by repeated phlebotomies and has been shown to be well tolerated and accepted by the patients (8). The main indications for EA for a PV patient (often newly diagnosed) are high risk Hct values of >55-60% that can be reduced to the normal range within 1-2 h. The long-lasting effect (median interval between 2 EA treatments: ca. 6 months) is partially the result of the massive loss of iron, a growth factor for erythropoesis. This has been shown by in vitro studies in erythroid progenitor cells of PV patients before and after EA (11). The advantages and possible disadvantages of EA treatment are discussed.