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PV resistant or intolerant to hydroxyurea per ELN criteria: persistent need for phlebotom...

Deterministic view of the source YAML entity. Clinical authority remains with the cited source IDs and reviewer sign-off state.

IDRF-PV-HU-RESISTANCE-INTOLERANCE
TypeRed flag
Statusreviewed 2026-04-25 | pending_clinical_signoff
DiseasesDIS-PV
SourcesSRC-NCCN-MPN-2025 SRC-RESPONSE-VANNUCCHI-2015

Red Flag Origin

DefinitionPV resistant or intolerant to hydroxyurea per ELN criteria: persistent need for phlebotomy on HU 2 g/day, persistent symptoms, splenomegaly progression, cytopenias at minimum effective HU dose, or HU-related cutaneous ulcers — switch to ruxolitinib (RESPONSE)
Clinical directionintensify
Categorytransformation-progression
Shifts algorithmALGO-PV-1L

Trigger Logic

{
  "any_of": [
    {
      "finding": "hu_resistance",
      "value": true
    },
    {
      "finding": "hu_intolerance",
      "value": true
    },
    {
      "finding": "hu_cutaneous_ulcers",
      "value": true
    },
    {
      "finding": "hu_dose_max_with_persistent_phlebotomy",
      "value": true
    }
  ],
  "type": "composite"
}

Notes

RESPONSE trial established ruxolitinib as 2L for HU-resistant / intolerant PV (Hct + spleen-volume composite primary endpoint 21% vs 1%). NOT applicable as 1L (no proven OS benefit over HU). Pegylated interferon-α (ropeginterferon) is alternative 2L / preferred for younger PV but access-limited. STUB — requires clinical co-lead signoff.

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Indications