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Treatment of the anemia of myelodysplastic syndromes using recombinant
human granulocyte colony-stimulating factor in combination with
erythropoietin [see comments]
RS Negrin, R Stein, J Vardiman, K Doherty, J Cornwell, S Krantz and PL Greenberg
Department of Medicine, Stanford University Medical Center, CA 94305.
We treated myelodysplastic syndrome patients (MDS) with both recombinant
human granulocyte colony-stimulating factor (G-CSF) and recombinant human
erythropoietin (EPO) to determine whether such combination therapy resulted
in improvement of their anemias. Twenty- four of 28 patients begun on study
completed the protocol and were evaluable for erythroid responses. Therapy
was initiated with G-CSF at 1 micrograms/kg administered by daily
subcutaneous injection and adjusted to either normalize or double the
neutrophil count. EPO was then administered by daily subcutaneous injection
at a dose of 100 U/kg and dose-escalated to 150 and 300 U/kg every 4 weeks
while continuing the G-CSF. Changes in absolute reticulocyte count,
hematocrit level, and need for RBC transfusions were compared with
pretreatment values as well as other blood cell counts. Ten of 24 patients
(42%) had erythroid responses, whereas all patients had neutrophil
responses. Six previously transfused patients no longer required RBC
transfusions during the treatment period. Erythroid responses were found to
be independent of patient age, French-American-British subtype, duration of
disease, prior RBC transfusion requirements, or cytogenetic abnormalities
at presentation. Pretreatment serum EPO levels were lower in
erythroid-responding as compared with nonresponding patients (median 157 v
600 U/L; P = .05). The combined treatment modality was generally well
tolerated. We conclude that a substantial percentage of MDS patients had
both erythroid and myeloid responses when treated with the combination of
G-CSF and EPO.
Volume 82,
Issue 3,
pp. 737-743,
08/01/1993
Copyright © 1993 by The American Society of Hematology
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