Natural history

ET generally follows an indolent course and life expectancy is near normal. The risk of life-threatening complications or of leukaemic transformation is very low. However, the risk of AML is increased by cytotoxic therapy and such treatment should be used cautiously. The need for therapy must be individualised balancing risks of therapy against thrombotic risks (e.g. cigarette smoking, family history), FBC results, co-morbidity and age. Risk of AML 5-10%; risk of evolution to myelofibrosis —5%.

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