What is the role of hydroxyurea (Hydro) in the treatment of essential thrombocythemia (ET)?

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Last updated: May 2, 2025View editorial policy

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From the Guidelines

Hydroxyurea is the recommended first-line treatment for essential thrombocytosis (ET) patients who are at high risk for thrombotic complications, as it has been shown to be effective in reducing platelet counts and preventing thrombotic events 1. The typical starting dose of hydroxyurea is 15-20 mg/kg/day, which can be adjusted based on platelet count response and side effects. The goal of therapy is to maintain platelet counts below 400,000/μL. Treatment is typically long-term or indefinite for high-risk patients. Some key points to consider when using hydroxyurea include:

  • Common side effects include cytopenias (particularly neutropenia), gastrointestinal symptoms, skin changes, and oral ulcers 1.
  • Regular blood count monitoring is essential, typically every 2 weeks during dose adjustment and then every 1-3 months once stable.
  • Hydroxyurea works by inhibiting DNA synthesis, effectively reducing platelet production in the bone marrow.
  • It's particularly indicated for ET patients who are over 60 years old, have a history of thrombosis, or have cardiovascular risk factors. For patients who fail hydroxyurea therapy or experience intolerable side effects, alternative treatments include interferon-alpha, anagrelide, or busulfan 1. In terms of specific patient populations, interferon alfa-2b has been shown to be effective for patients with JAK2-mutated and CALR-mutated ET 1.

From the Research

Essential Thrombocytosis Treatment

There is no direct evidence of "hydro tires" being related to essential thrombocytosis. However, the term "hydro" might be referring to hydroxyurea, a medication used to treat essential thrombocytosis.

  • Hydroxyurea is a commonly used treatment for essential thrombocytosis, particularly for high-risk patients 2, 3, 4, 5.
  • The goal of treatment is to prevent thrombosis and bleeding, and to minimize the risk of malignant transformation and/or post-essential thrombocytosis myelofibrosis 3, 4, 5, 6.
  • Treatment strategies are based on risk assessment, which takes into account factors such as age, prior thrombosis history, and cardiovascular risk factors 2, 3, 4, 5, 6.
  • Low-dose aspirin is also commonly used in the treatment of essential thrombocytosis, particularly for low-risk patients 2, 3, 4, 5.
  • Other treatment options, such as interferon-alpha and anagrelide, may be used in certain cases, such as for patients who are resistant or intolerant to hydroxyurea 2, 3, 4, 5.

References

Guideline

Guideline Directed Topic Overview

Dr.Oracle Medical Advisory Board & Editors, 2025

Research

Management of essential thrombocythemia.

Hematology. American Society of Hematology. Education Program, 2011

Professional Medical Disclaimer

This information is intended for healthcare professionals. Any medical decision-making should rely on clinical judgment and independently verified information. The content provided herein does not replace professional discretion and should be considered supplementary to established clinical guidelines. Healthcare providers should verify all information against primary literature and current practice standards before application in patient care. Dr.Oracle assumes no liability for clinical decisions based on this content.

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