Abstract
Therapeutic approaches are not well established in patients with myelodysplastic syndrome (MDS). We evaluated response to cyclosporin A (CyA) in 19 cases with MDS who were enrolled for the study [13 refractory anemia (RA), 5 refractory anemia with excess of blasts (RAEB), and 1 refractory anemia with ringed sideroblasts (RARS)]. Bone marrow was normocellular in ten, hypercellular in five, and hypocellular in four cases. Fifteen patients were transfusion dependent and the rest were not transfusion dependent but with a hemoglobin range of 6.4–8.8 g% with a mean of 7.4 g%. CyA was given at a dose of 3–5 mg/kg per day. A major response was observed in seven patients with RA, which was sustained on follow-up. Four cases of RA showed minor response and two cases of RA did not respond to CyA therapy. A minor response was also seen in one RAEB and one RARS case, while one RAEB case that initially showed a major response relapsed on therapy. The first effect of therapy was evident after a mean period of 2.5 months. A rise in platelets and leukocyte count was seen in three and two cases, respectively. One case developed renal failure on therapy and later died of septicemia. Response to CyA was independent of bone marrow cellularity. CyA could be an effective mode of therapy in patients with MDS especially those having RA.
Similar content being viewed by others
References
Koeffler HP (1996) Myelodysplastic syndromes. Semin Hematol 33:87–94
Kouides PA, Bennet JM (1996) Morphology and classification of myelodysplastic syndrome and their pathological variants. Semin Hematol 33:95–110
Tuzuner N, Cox C, Rowe JM, Watrous D, Bennet JM (1995) Hypocellular myelodysplastic syndrome: new proposals. Br J Haematol 91:612–617
Fohlmeister I, Fischer R, Modder B, Rister M, Shaeffer HE (1985) Aplastic anemia and hypoplastic myelodysplastic syndrome: histomorphological, diagnostic and prognostic features. J Clin Pathol 38:1218–1224
Bacigalupo A, Broccia G, Corda D, Arcese W, Carotenuto M, Gallamini A, Locatelli F, Mori PG, Saracco P, Todeschini G et al (1995) Antithymocyte globulin, cyclosporine and granulocyte colony stimulating factor in patients with acquired aplastic anemia (SAA): a pilot study of EBMT SAA working party. Blood 85:1348–1353
Miescher PA, Favre H, Beris P (1991) Autoimmune myelodysplasias. Semin Hematol 28:322–330
Muller EW, De Wolfe JT, Vallenga E (1993) Successful immunosuppressive treatment after failure of erythropoietic therapy in two subjects with refractory anemia. Br J Hematol 83:171–172
Biesma DH, van den Tweel JG, Verdonck IF (1997) Immunosuppressive therapy for hypoplastic myelodysplastic syndrome. Cancer 79:1548–1551
Jonasova A, Neuwirtova R, Cermak J, Vozobulova V, Mocikova K, Siskova M, Hochova I (1998) Cyclosporin A therapy in hypoplastic MDS patients and certain refractory anaemias without hypoplastic bone marrow. Br J Haematol 100:304–309
Shimamoto T, Iguchi T, Ando K, Katagiri T, Tauchi T, Ito Y, Yaguchi M, Kimura Y, Masuda M, Mizoguchi H, Ohyashiki K (2001) Successful treatment with cyclosporin A for myelodysplastic syndrome with erythroid hypoplasia associated with T-cell receptor gene rearrangements. Br J Haematol 114:358–361
Molldrem JJ, Caples M, Mavroudis D, Plante M, Young NS, Barrett AJ (1997) Antithymocyte globulin for patients with myelodysplastic syndrome. Br J Haematol 99:699–705
Asano Y, Maeda M, Uchida N, Yokoyama T, Osaki K, Shimoda K, Gondo H, Okamura T, Okamura S, Niho Y (2001) Immunosuppressive therapy for patients with refractory anemia. Ann Hematol 80:634–638
Imai Y, Fukuoka T, Nakatani A, Ohsaka A, Takahashi A (1996) Sustained trilineage recovery and disappearance of abnormal chromosome clone in a patient with myelodysplastic syndrome following combination therapy with cytokines (granulocyte colony-stimulating factor and erythropoietin) and high-dose methylprednisolone. Br J Haematol 93:146–150
Cheson BD, Bennet JM, Kantarjian H, Pinto A, Schiffer CA, Nimer SD, Lowenberg B, Beran M, de Witte TM, Stone RM, Mittelman M, Sanz GF, Wijermans PW, Gore S, Greenberg PL (2000) Report of an international working group to standardize response criteria for myelodysplastic syndrome. Blood 96:3671–3674
Enright H, Jacob SH, Vercellotti G, Howe R, Belzer M, Miller W (1995) Paraneoplastic autoimmune phenomenon in patients with myelodysplastic syndrome: response to immunosuppressive therapy. Br J Haematol 91:403–408
Young NS (1992) Problem of clonality in aplastic anemia. Blood 79:1385–1392
Hamblin TJ (1996) Immunological abnormalities in myelodysplastic syndromes. Semin Hematol 33:150–162
Mufti GJ, Figes A, Hamblin TJ, Oscier DG, Copplestone JA (1986) Immunological abnormalities in myelodysplastic syndromes. Br J Haematol 63:143–147
Editorial (1985) Cyclosporine in autoimmune disease. Lancet i:211–909
Trucco M, Rovera G, Ferrero D (1984) A novel human lymphokine that inhibits hematopoietic progenitor cell proliferation. Nature 309:166–168
Nand S, Godwin JE (1988) Hypoplastic myelodysplastic syndrome. Cancer 62:958–962
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Dixit, A., Chatterjee, T., Mishra, P. et al. Cyclosporin A in myelodysplastic syndrome: a preliminary report. Ann Hematol 84, 565–568 (2005). https://doi.org/10.1007/s00277-005-1016-6
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00277-005-1016-6