Deflazacort in the treatment of haematologic disorders
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Glucocorticoids (GCs) exert different activities that are useful for the treatment of several haematologic disorders. The synergistic effect with cytotoxic drugs is important for the therapy of lymphoprolyferative diseases. The inhibition of macrophages prevents acute haemolisys and platelets destruction in autoimmune disorders; moreover GCS are the most important agents for the management of vasculitis complicating cryoglobulinaemia.
Deflazacort (DFZ) has similar immunomodulating effects to other GCs but, by contrast, DFZ produces less hypercalciuria and hyperglycaemia than prednisone and dexamethasone. As a result, the adverse effects of prolonged treatment are less with deflazacort.
In this paper we report the results obtained with DFZ containing treatment in 27 patients affected by haematological disorders: 12 patients with advanced low or intermediate grade non Hodgkin's lymphoma submitted to 6 courses of combination chemotherapy, 10 patients with acute idiopatic thrombocytopenic purpura and 5 patients with wascular purpura secondary to type 2 cryoglobulinaemia.
DFZ was substituted for prednisone or 6-methylprednisolone at a dose calculated in accordance with the PDN: DFZ ratio of 0.78. The results were in accordance within what would be expected with standard treatments containing conventional GCs, whereas in most patients, the side-effects were negligible.
Key wordsDeflazacort Haematological disorder immunosuppression glucocorticoid
- 1.Cupp TR, Fauci AS (1982) Corticosteroid-mediated immunoregulation in man Immunol Rev 65: 133Google Scholar
- 2.Beutler B, Cerami A (1987) Cachectin: more than a tumor necrosis factor. N Engl J Med 316: 379–385Google Scholar
- 3.Dinarello CA, Mier JW (1986) Interleukins. Annu Rev Med 37: 173Google Scholar
- 4.Lew W, Oppenheim JJ, Matsushima K (1988) Analysis of the suppression of IL-1 a and IL-1 B production in human peripheral blood mononuclear adherent cells by a glucocorticoid hormone. J Immunol 140: 1895–1901Google Scholar
- 5.Goodwin JS, Artluru D, Sierakowski S, Lianos EA (1986) Mechanism of action of glucocorticoids Inhibition of T cell proliferation and interleukin 2 production of hydrocortisone is reversed by leukotriene B. J Clin Invest 77: 1244–1249Google Scholar
- 6.Gatti G, Cavallo R, Sartori M, Marinone C, Angeli A (1986) Cortisol at physiological concentrations and prostaglandin E2 are active inhibitors of human natural killer cell activity. Immunopharmacology 11: 119–125Google Scholar
- 7.Scudeletti M, Castagnetta L, Imbimbo B, Puppo F, Pierri I, Indiveri F (1990) New glucocorticoids Mechanisms of immunological activity at the cellular level and the clinical setting. Ann NY Acad Sci vol 595: 368–382Google Scholar
- 8.Fauci AS, Leavitt RY (1989) Vasculitis in arthritis and allied conditions: a textbook of rheumatology 11 th edn, McCarty, DJ (ed) Lea & Febiger, Philadelphia, pp 1166Google Scholar
- 9.Fauci AS (1986) Mechanisms of corticosteroid action on lymphocyte subpopulations II. Differential effects of in vivo hydrocortisone, prednisone and dexamethasone on in vitro expression of lymphocyte function. Clin Exp Immunol 24: 54–62Google Scholar
- 10.Nathansohn GG, Winters G, Testa E (1979) Steroid possessing nitrogen III. Synthesis of new highly active corticoids (17 alpha, 16 alpha-d) oxazoline steroids. J Med Chem 10: 799–786Google Scholar
- 11.Buniva G, Dubini A, Sassella D (1979) Human biossay of corticotropin suppressing eosinopenic and hyperglycaemic potencies of deflazacort and prednisone. Curr Ther Res 26: 69–74Google Scholar
- 12.Gennari CB, Imbimbo B, Montagnani M (1984) Effects of short and mediumterm treatments with prednisone and deflazacort on mineral metabolism and parathyroid hormone activity in humans. Calcif Tissue Int 36: 245–252Google Scholar
- 13.Pagano G, Lombardi A, Feraris GM, Imbimbo B, Cavallo Perin P (1982) Acute effect of prednisone and deflazacort on glucose tolerance in pediatric subjects Eur J Clin Pharmacol 22: 469–471Google Scholar
- 14.Gerard-Marchand R, Hamlin L, Lennert K, Rilke F, Stansfeld AG, Van Unnik JAM (1974) Classification of non Hodgkin's lymphomas. Lancet II: 406–408Google Scholar
- 15.Carbone PP, Kaplan HS, Musshoff K, Smithers WW, Tubiana M (1971) Report of the committee on Hodgkin's disease staging classification. Cancer Res 31: 1860–1861Google Scholar
- 16.Gallagher G J, Gregory WM, Jones AE, Stanfeld AG, Richards MA, Dhaliwal HS, Malpas JS, Lister A (1986) Follicular lymphoma: prospectic factors for response and survival. J Clin Oncol 4: 1470–1480Google Scholar
- 17.De Fino SM, Lachant LM, Kirschner JJ, Gottlieb AS (1980) Adult idiopathic thrombocytopenic purpura. Clinical findings and response to therapy. Ann J Med 69: 430–442Google Scholar
- 18.Manoharan A (1991) Treatment of refractory idiopathic trombocytopenic purpura in adults. Br J Haematol 79: 143–147Google Scholar
- 19.Monteverde A, Rivano MT, Allegra GC, Monteverde AI, Zigrossi P, Baglioni P, Gobbi M, Falini B, Bordin G, Pileri S (1988) Essential mixed crioglobulinemia. Type II: a manifestation of a low grade malignant lymphoma? Acta Haemat 79: 20–25Google Scholar