The use of selective immunosuppressive therapy on myelodysplastic syndromes in targeted populations results in good response rates and avoids treatment‐related disease progression

Abstract

To determine the treatment response and disease progression in strictly selected patients with myelodysplastic syndrome undergoing immunosuppressive therapy (IST), patients were required to have an international prostate symptom score (IPSS) score 1.0 and at least one of the following conditions: (1) expression of the HLA-DR15 allele, (2) bone marrow (BM) cellularity of less than 30%, and (3) abnormal immune index of BM T-lymphocytes.The exclusion criteria were as follows: (1) 5% marrow myeloblasts, (2) poor karyotype, and (3) diagnosis of concurrent nonhematological malignancy. Patients received antithymocyte globulin followed by cyclosporine A (CsA) or CsA alone for at least 3 months. Seventy-one cases were analyzed. The total response rate was 77.5% (55/71 cases) with 11 complete responses. The response rate was positively correlated with the number of recruitment criteria met. Patients with an abnormal CD8, an abnormal CD4, or both had similar response rates. Patients who responded to treatment had significantly lower Th1 and Tc1 levels after treatment (P < 0.01 and P < 0.001, respectively), and six of eight patients with abnormal chromosomes did not show obviously abnormal clonal expansion when reassessed after IST. During the median observation period of 24 months, only two cases exhibited disease progression. At the median observation of 24 months, 35 of 55 responders (63.6%) maintained a hematological response, and 60 of 71 patients (84.5%) were still alive. The strictly selective use of IST may yield high response rates and can avoid treatment-related acute myeloid leukemia transformation. IST significantly reduces Th1 and Tc1 levels without causing malignant clonal expansion. Am. J. Hematol. 87:26-31, 2012. V

Interleukin‐17 enhances the production of interferon‐γ and tumour necrosis factor‐α by bone marrow T lymphocytes from patients with lower risk myelodysplastic syndromes

“…Some patients were treated with cyclosporine A (CsA) (Novartis Pharma Schweiz AG) (3–5 mg/kg/d) according to the guidelines described in a previous study . Therapies were continued for 1–2 months after the patients' haematological parameters improved before the doses were gradually reduced to reach the minimal dose, defined as the dose at which peripheral blood counts were maintained without requiring transfusion.…”

Adverse Drug Reactions Causing Hospital Admissions in Childhood: A Prospective, Observational, Single‐Centre Study

“…In this study, three different patients were admitted due to probable cyclosporine toxicity. One of the patients was treated for myelodysplastic syndrome (MDS), the treatment of which is based on immunosuppressive therapy that includes cyclosporine . This patient was admitted because of nausea and vomiting probably caused by toxic plasma levels of cyclosporine.…”

Part 3: Myelodysplastic syndromes—Treatment of low-risk patients without the 5q deletion

“…Of the 71 cases, 60 (84.5%) were alive at the end of the 24-month follow-up period. During this follow-up, 69 patients remained without increased blast cell counts or leukemic transformation 13 (B).…”