About 1 in 4 individuals with polycythemia vera (PV) with high-risk status or poor hematocrit control develop resistance to or are intolerant of cytoreductive therapy with hydroxyurea. In these instances, ruxolitinib provides hematocrit control, reduces spleen size, normalizes blood counts, and improves PV-related symptoms, according to a recent review.

For many patients, PV is managed in a community health setting, and it is important that community hematologists, oncologists, and internists are familiar with the contemporary management of PV to improve patient outcomes, including management for patients who present with unique health-care needs.

The review provides an overview of current treatment options for patients with PV and discusses challenging circumstances encountered by community providers in the management of PV, including symptom assessment, identification of hydroxyurea resistance/intolerance, pregnancy, elective surgeries, concomitant immunosuppressants, and managing patients in areas with limited access to specialized hematologic care.