| Safety | Efficacy | |
|---|---|---|
| Before treatment | ||
| Before treatment | Exclusion of contraindications (per drug label) | Measure spleen size by echography |
| Before treatment | Search for potential cardiac or ophthalmologic abnormalities | Assess driver mutation allele burden |
| Before treatment | Screen for autoimmunity (at least antinuclear Ab) and TFT | If possible screen for additional mutations by NGS |
| Treatment initiation | ||
| Treatment initiation | Start at low dose | Titration until CHR |
| peg-IFN-α2a | 45 μ/wk | By 45 μ/2wk Max dose 180 μ/wk |
| ropegIFN-α2b | 100 μ/2wk | By 50 μ/2wk Max dose 500 μ/2wk |
| Monitoring during treatment | ||
| Monitoring during treatment | Screen for mood disturbances, thyroid dysfunction, type 1 diabetes | CBC/mo |
| Monitoring during treatment | CBC/mo | Spleen size and mutation/y |
| Monitoring during treatment | LFT, TFT/6 mo | |
| Dose adjustments | ||
| Dose adjustments | According to potential toxicities | Progressive decrease after 1 year in case of lasting CHR |
| pegIFN-α2a | By 45 μ per injection every 6 months down to 45 μ/wk, then by expanding interval to every 2wk | |
| ropegIFN-α2b | By 50 μ per injection every 6 months down to 100 μ/2wk, then by expanding interval to every 4wk | |
| Discontinuation | ||
| Discontinuation | In case of intolerance | In patients with at least 2 years of continuous CHR on IFN and JAK2 V617F VAF <10% |
Clinical Guidelines for Peg-IFN-α Usage in Practice
3.1 Table . How I use peg-IFN-α in practice
3.1.1 Abbreviations
Ab, antibodies; CBC, complete blood count; LFT, liver function tests; NGS, next-generation sequencing; TFT, thyroid function tests.
3.2 Additional Notes
- CHR: Complete Hematologic Response
- Driver mutations: Primarily JAK2, CALR, and MPL mutations
- VAF: Variant Allele Frequency ```