Clinical and Biological Effects of Erythropoietin treatment of Myelodysplastic Syndrome

Razzano, Monica; Caslini, Corrado; Cortelazzo, Sergio; Battistel, Vittorio; Barbui, Tiziano

doi:10.3109/10428199309147366

Cited by 4 publications

(1 citation statement)

References 30 publications

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“…L Anemic to point of red blood cell dependence or hematocrit <28%-30%: A trial of erythropoietin is worth trying (≥~50% probability of response) if patients have the following clinical characteristics: FAB subtype refractory anemia [111][112][113], baseline serum erythropoietin level <100 IU/1 [111,[114][115][116], red cell transfusion independence [42], and "early" response (i.e., within the first eight weeks) [116]. The dose should be a minimum of 450 u/kg/week total s.c., usually given as a divided dose three times a week [117].…”

Section: The Low-risk or Intermediate-1groupmentioning

confidence: 99%

Understanding the Myelodysplastic Syndromes

Kouides

Bennett

1997

The Oncologist

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The myelodysplastic syndrome (MDS) remains challenging to the clinician in terms of diagnosis and management. The diagnosis is essentially one of exclusion in first ruling out other disorders that can also cause peripheral blood/bone marrow cell dysplasia and cytopenias. The distinguishing biological characteristic of MDS is that it is a clonal disorder of the marrow with impaired differentiation. Recent studies implicate extensive apoptosis as the explanation of the paradoxical observation of marrow hyperplasia but peripheral blood cytopenia. Neutropenia and/or neutrophil dysfunction account for the primary clinical manifestation of MDS in terms of an increased risk for infection, which is the leading cause of death in MDS. The clonal nature of MDS places it also at continual risk for transformation to acute leukemia. Predicting overall survival as well as the risk of AML transformation has been improved by the recent development of a scoring system (International Prognostic Scoring System) that incorporates three laboratory variables: percent of marrow blasts, degree of cytopenias, and presence of chromosomal abnormalities. Based on these variables, four prognostic subgroups can be delineated ranging from low risk with a median survival of 5.7 years, to high risk with a median survival of 0.4 years. Management of MDS can now be based on the patient's respective prognostic subgrouping, with low‐risk patients being considered for hematopoietic growth factor singly or in combination if at the point of red cell transfusion dependence and/or neutropenia with recurrent infections, while high‐risk patients should be offered AML‐induction therapy or novel agents such as Topotecan. One must individualize further in patients in the remaining intermediate groups, I and II, in choosing the most appropriate therapy. Future advances upon understanding the molecular details of the MDS clone should ultimately improve the care of patients with MDS.

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Section: The Low-risk or Intermediate-1groupmentioning

confidence: 99%

Understanding the Myelodysplastic Syndromes

Kouides

Bennett

1997

The Oncologist

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Advances in the therapy of the myelodysplastic syndromes

Kouides

Bennett²

Diagnostic and Therapeutic Advances in Hematologic Malignancies

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The use of r‐HuEpo in the treatment of anaemia related to myelodysplasia (MDS)

Rose¹,

Abels

Nelson

et al. 1995

Br J Haematol

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One hundred and sixteen (1 16) anaemic patients with myelodysplastic syndromes (MDS) were treated with recombinant human erythropoietin (r-HuEpo) in an openlabel, multicentre, compassionate treatment trial: 100 patients received therapy for > 4 weeks and were evaluable for efficacy. The distribution of FAB subtypes was: 44RA. 40 RARS, eight RAEB, two RAEB-t, one CMML, and five not specified. Mean baseline haematocrit was 245%, and the mean prestudy transfusion requirement in the 12 weeks immediately prior to study entry was 6.5 units. r-HuEpo treatment was initiated at a dose of 150U/kg three times weekly, with dose escalations of SOU/kg monthly (up to 300U/kg 3 x/week) permitted if the haematocrit failed to rise. Response to therapy was defined as either an increase in haematocrit of > 6 percentage points over baseline, unrelated to transfusion, or a > SO% decrease in transfusion requirement in the last 3 months of study treatment, compared to the baseline period (12 weeks). By these criteria, 28% (28/100) of patients responded to r-HuEpo treatment. Overall, 86% (24/28) of patients responding to therapy had baseline Epo levels < 100mU/ml. Response rates by FAB subtype were: RA 39% (17/44), RARS 17.5% (7/40) andRAEB 12.5% (1/8). Additionally, a 54% (15/28) response rate was seen in RA patients with baseline EPo levels < 100mU/ml. Responses to therapy were durable and generally occurred at r-HuEpo doses of 150-200 U/ kg t.i.w. There were no reports of thrombosis, seizures or therapy-related hypertension. The data show that patients with MDS, especially those with the RA and RARS subtypes, can benefit from treatment with r-HuEpo. Those patients with baseline Epo levels < 100mU/ml were most likely to respond to therapy.

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Clinical and Biological Effects of Erythropoietin treatment of Myelodysplastic Syndrome

Cited by 4 publications

References 30 publications

Understanding the Myelodysplastic Syndromes

Understanding the Myelodysplastic Syndromes

Advances in the therapy of the myelodysplastic syndromes

The use of r‐HuEpo in the treatment of anaemia related to myelodysplasia (MDS)

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