Treatment of polycythemia vera with melphalan (Hebrew)

Fifteen patients with polycythemia vera were treated with melphalan. All had been treated previously with either P³², bisulphan, chlorambucil or repeated phlebotomy. The induction dose of melphalan was 2 to 4 mg/day, and the maintenance dose 2 to 6 mg/week. Response to therapy was noted within 3 to 10 weeks, sooner than with any other cytotoxic drug. All patients responded with a reduction in hematocrit and leukocyte and platelet counts to normal values. This was accompanied by disappearance of complaints such as pruritus, anginal pain, headache and dizziness in 11 patients. Mild thrombocytopenia (80 to 100,000/mm³) developed in 6 patients and leukopenia of 1700/mm³ in 1 but disappeared after stopping treatment temporarily. One patient previously treated with P³², bisulphan and chlorambucil, died of chronic myelogenous leukemia. The rapid clinical and hematological response and the minimal side effects encourage continued use of this therapy in form]) vera. However, the data reported here do not allow evaluation of possible long term carcinogenic effects.