THERAPY PROCEDURES

POLYCYTHEMIA VERA

INDICATIONS:

1. Erythrocytosis uncontrollable by phlebotomy alone.
2. Excessive thrombocytosis with platelet counts approaching one million.
3. Extramedullary hematopoiesis with painful spleen, hypersplenism, abdominal pain, or splenic infarct.
4. Persistent symptoms such as pruritus or hyperuricemia not controlled by phlebotomies, allopurinol, or antihistamines.
5. Cardiovascular problems contraindicating frequent phlebotomies.

PATIENT PREPARATION:

None.

RADIOPHARMACEUTICAL:

An IV dose of 2 to 3 mCi/m2 body surface area of P-32 as sodium phosphate is administered by the nuclear medicine physician.

PROCEDURE TIME:

20 minutes.

FOLLOW-UP:

1. The patient usually returns to the care of his/her referring physician.
2. If remission does not occur in 3 months, the patient may be retreated with a dose 25% greater than the initial dose.
3. If remission does not occur in an additional 3 months, the patient may be retreated with a dose 25% greater than the first retreatment dose, but not to exceed 7 mCi.

POSSIBLE COMPLICATIONS:

There are several possible serious complications. First, there is a 1% or less chance of severe bone marrow depression which might require transfusions. Second, there is a 10-15% incidence of leukemia in patients with polycythemia vera treated with P-32. However, the observed increased incidence of leukemia may be related primarily to the disease process rather than treatment with P-32. Third, if any of the P-32 infiltrates the skin at the time of injection, it may cause local skin damage.

P-32 THERAPY FOR POLYCYTHEMIA VERA

Nuclear Medicine Department

UNIVERSITY OF ILLINOIS HOSPITAL

Your physician has referred you for a treatment of radioactive phosphorus for polycythemia vera. Other methods of therapy may be available, but this particular treatment is felt to be best in your situation at this time.

We are attempting to slow down the rate at which your bone marrow produces blood cells. However, results are not always successful and additional treatments may be required.

There are several possible serious complications. First, there is a 1% or less chance of severe bone marrow depression which might require transfusions. Second, there is a 10-15% incidence of leukemia in patients with polycythemia vera treated with P-32. However, the observed increased incidence of leukemia may be related primarily to the disease process rather than treatment with P-32. Third, if any of the P-32 infiltrates the skin at the time of injection, it may cause local skin damage.

There is an approximately 50% chance of nausea and vomiting which would be self-limited.

Female patients who may be pregnant should not undergo this therapy.

Please feel free to ask questions at any time.

__________________________ __________________________

Patient or legal guardian Physician

____________________________________________________

Witness Date

REFERRAL INFORMATION

Patient name___________________ Referring physician________________

Patient weight ____ Hematocrit_____ White blood cell count_________

Platelets________ Splenomegaly________ Total blood volume__________

pO2______ Other therapy____________________________________________

Comments___________________________________________________________________________________________________________________________

Dose of P-32 (sodium phosphate) to be ordered__________________

Treatment date_______

Nuclear medicine physician_________________________________ date____________