Recombinant erythropoietin for myelodysplastic syndromes

Advances in the therapy of the myelodysplastic syndromes

The study of the proliferation and differentiation of the MDS clone at the molecular level, including the details of apoptosis, may hopefully lead to more effective differentiation-induction/antiapoptotic agents. The study of the cytokines at the cellular/molecular level may lead to more effective trails of combination therapy with differentiation-induction agents, chemotherapy, and/or early-acting cytokines. Further phenotypic characterization of the MDS clone may lead to negative selection of these cells or positive selection of normal stem cells as part of an autotransplant strategy, as is presently being done in chronic-phase chronic myeologenous leukemia. The use of agents such as the topoisomerase I inhibitors (e.g., topotecan), which have mechanisms of action disparate from agents already used in MDS, may increase the efficacy of chemotherapy for MDS. The further clinical refinements in reducing treatment-related mortality and the study of T cells at the molecular level may hopefully lead to improvement in the prevention and therapy of graft-versus-host disease, in turn increasing the upper age limit of allogeneic BMT for MDS and increasing the feasibility of matched unrelated allogeneic BMT. At present, we can tailor the approach to a MDS patient based on his or her IPSS risk stratification, degree of cytopenia, and age, as outlined in Figure 2. At present, we can tailor the approach to a MDS patient based on his or her IPSS risk stratification, degree of cytopenia, and age, as outlined in Figure 2.

A pilot trial of 13-cis-retinoic acid and alpha-tocopherol with recombinant human erythropoietin in myelodysplastic syndrome patients with progressive or transfusion-dependent anemias. The Central Pennsylvania Oncology Group

A pilot study was performed to determine the efficacy of 13-cis-retinoic acid (CRA) and alpha-tocopherol (AT) with increasing doses of recombinant human erythropoietin (rHuEPO) in anemic patients with primary myelodysplastic syndrome (MDS), to determine response rate and to determine the dose requirement and long-term effects of rHuEPO therapy on the transition to acute non-lymphocytic anemia and survival of these patients. Twenty-four consecutive MDS patients were entered into the study. Patients were stratified according to their FAB classification at study entry. Therapy consisted of a 6 month trial of CRA (100 mg m(-2) day(-1) and AT (800 mg day(-1)) with rHuEPO (150 units kg(-1) body weight subcutaneously three times a week). The rHuEPO dose was escalated to daily doses at 2 months, and 300 U kg(-1) body weight given three times a week for another 2 months and continuing therapy after 6 months in responsive patients. Response was measured by elimination of transfusions requirement (partial response, PR) and normal hemoglobin level and complete blood counts (complete response, CR). Observed responses for the 23 evaluable patients were 2 CR and 6 PR (34.8%). Odds ratio analysis showed that patients with anemia alone were 14 times more likely to respond than patients with pancytopenia (p = 0.06). In our study, two patients (8%) transformed to acute leukemia in CRA + AT + rHuEPO-treated patients. Median survival of 34 months with a median follow-up of 17 months (range 3-70 months) was observed. The response rates with the addition of rHuEPO to CRA and AT was similar but occurs earlier at 2 months compared to 6-10 months with CRA and AT alone and did not alter survival. There was no increase in the risk for leukemia in the group treated with rHuEPO. Response to either therapy appeared to be limited to patients in the early stages of MDS.