Erythropoietin therapy of myelodysplastic syndromes [letter; comment]

Jd, Shepherd; Currie, CJ; Sparling, TG; Krystal, G; Eaves, AC

doi:10.1182/blood.v79.7.1891b.bloodjournal7971891b

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“…Pooling available literature data shows that 125 out of 515 patients who received EPO alone achieved an erythroid response (≈ 24%) (Bessho et al , 1990; Oster et al , 1990; Stebler et al , 1990; Bowen et al , 1991; Hellstroem et al , 1991; van Kamp et al , 1991; Laporte et al , 1991; Schouten et al , 1991; Stein et al , 1991; Kurzrock et al , 1991; Cazzola et al , 1992; Ganser & Hoelzer, 1992b; Rafanelli et al , 1992; Razzano et al , 1992; Shepherd et al , 1992; Verhoef et al , 1992; Aloe Spiriti et al , 1993; Ghio et al , 1993; Goy et al , 1993; Depaoli et al , 1993; Ludwig et al , 1993; Mittelman, 1993; Mohr et al , 1993; Shapiro et al , 1993; Stenke et al , 1993; Urabe et al , 1993; Yoshida et al , 1993; Zeigler et al , 1993; Isnard et al , 1994; Stone et al , 1994; Rose et al , 1995).…”

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confidence: 99%

Treatment of anaemia in myelodysplastic syndromes with prolonged administration of recombinant human granulocyte colony‐stimulating factor and erythropoietin

et al. 2000

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Summary. Treatment with recombinant human erythropoietin (rhEPO) improves anaemia in < 20% of the patients with myelodysplastic syndromes (MDS). Recent reports suggest that a combination treatment with rhEPO plus recombinant human granulocyte colony-stimulating factor (rhG-CSF) given for up to 18 weeks may result in a higher erythroid response rate than with rhEPO alone. We investigated the potential advantage of an even more prolonged schedule of combined rhG-CSF and rhEPO treatment to obtain and maintain stable responses. In a phase II study, 33 patients with MDS [17 with refractory anaemia (RA), eight with RA with ringed sideroblasts (RARS), eight with RA with excess blasts (RAEB) with bone marrow blast counts less than 20%] were scheduled to receive at least 36 weeks of combined therapy with rhG-CSF and rhEPO. Seventeen of 28 evaluable patients demonstrated an erythroid response [61%; 95% confidence interval (CI) 41±78] after 12 weeks of treatment. The erythroid response rate was 80% (20 of 25 evaluable patients; 95% CI 59±93) after 36 weeks. Seven of these responses developed between week 12 and week 36, whereas two initially responding patients became refractory. The cytokine therapy was generally well tolerated. Nineteen of the 20 patients responding after 36 weeks continued to be treated with both cytokines. After 1 year and 2 years of continuous combined treatment, 50% of the initially included patients showed a continuing response. Our results suggest that a prolonged combination treatment with rhG-CSF and rhEPO is highly effective in achieving a stable and long-lasting erythroid response in many patients with MDS and low blast count.

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