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Erythropoietin in the treatment of patients with myelodysplastic syndrome


Authors: J. Čermák
Authors‘ workplace: Ústav hematologie a krevní transfuze, Praha, ředitel prof. MUDr. Pavel Klener, DrSc.
Published in: Vnitř Lék 2005; 51(10): 1102-1107
Category: Original Contributions

Overview

Aim:
The aim of the study was to evaluate the indication of erythropoietin in patients with myelodysplastic syndrome (MDS).

Methods:
Twenty patients with MDS of RA or RARS subtype (according to the FAB classification) were treated with recombinant human erythropoietin (rHuEPO) in the dose of 150 IU/kg 3 times per week for 12 weeks, in 1 patient with profound granulocytopenia rHuEPO was combined with G-CSF in the dose of 300 μg 3 times per week. The criteria for complete response (CR) were achievement of Hb ≥ 115 g/l and transfusion independence, increase in Hb ≥ 15 g/l and transfusion independence were evaluated as a partial response (PR).

Results:
CR was observed in 4 patients (20 %), 4 patients (20 %) achieved PR. After exclusion of 3 patients in whom the favourable response to rHuEPO might be influenced by presence of incipient renal insufficiency, the CR + PR rate was 25 %. In 16 patients who responded to the treatment at least by increase in Hb ≥ 5 g/l or by decrease in the number of transfusions, the administration of rHuEPO was continued in the same dose for additional 12 weeks, nevertheless, no further CR or PR were observed after prolonged treatment. Concomitant administration of oral iron chelator deferiprone in the dose of 2 – 3 g/day in 5 patients with serum ferritin > 2000 μg/l resulted in 1 patient with PR to rHuEPO in a significant decrease of serum ferritin level and increase of urinary iron excretion. In 3 other patients with not sufficient response to rHuEPO a concomitant oral iron chelation enabled to stabilize serum ferritin level despite continuing iron load from red blood cell transfusions.

Conclusions:
Initial level of serum EPO < 100 IU/l, Hb > 85 g/l and dependence on administration of ≤ 2 TU red blood cell transfusions per month before starting treatment were predictive factors for response to rHuEPO administration. In patients with combination of these parameters, CR+ PR rate was 89 % suggesting that this subset of MDS patients with RA should be indicated for treatment with rHuEPO. Combination ot rHuEPO with G-CSF represents an expensive treatment approach and should be limited for patients with RARS, serum EPO < 500 IU/l and dependence on ≤ 2 TU of red blood cells transfusion per month.

Key words:
myelodysplastic syndrome – anemia – growth factors – erythropoietin – iron overload – chelation


Sources

1. Asano H, Ohashi H, Ichibara M et al. Evidence for nonclonal hematopoietic progenitor cell populations in bone marrow of patients with myelodysplastic syndromes. Blood 1994; 84: 588-594.

2. Bennett JM, Catovsky D, Daniel MT et al. Proposals for the classification of the myelodysplastic syndromes. Br J Haematol 1982; 51: 189-199.

3. Bowen D, Culligan D, Jacobs A. The treatment of anaemia in the myelodysplastic syndromes with recombinant human erythropoietin. Br J Haematol 1991; 77: 419-423.

4. Bowen DT, Hellström-Lindberg E. Best supportive care for the anaemia of myelodysplasia: inclusion of recombinant erythropoietin therapy? Leuk Res 2001; 25: 19-21.

5. Bowen D, Culligan D, Jowitt S et al. Guidelines for the diagnosis and therapy of adult myelodysplastic syndromes. Br J Haematol 2003; 120: 187-200.

6. Casadevall N, Nataf J, Viron B et al. Pure red-cell aplasia and antierythropoietin antibodies in patients treated with recombinant erythropoietin. N Engl J Med 2002; 346: 469-475.

7. Casadevall N, Durieux P, Dubois S et al. Health, economic, and quality-of-life effects of erythropoietin and granulocyte colony-stimulating factor for the treatment of myelodysplastic syndromes: a randomized, controlled trial. Blood 2004; 104: 321-327.

8. Cheson BD, Bennett JM, Kantarjian H et al. Report of an international working group to standardize response criteria for myelodysplastic syndrome. Blood 2000; 96: 3671-3674.

9. Čermák J, Brabec V, Indrák K. Combination of recombinant human erythropoietin and iron chelator L1 (deferiprone) in the treatment of iron overload in a patient with inherited hemoglobin disorder. Int J Hematol 1996; 64: S 35 (abstr).

10. Čermák J, Gregora E, Lachmanová J et al. Sledování zásob železa u nemocných s chronickým selháním ledvin léčených rekombinantním lidským erytropoetinem. Vnitř Lék 1994; 40: 174-178.

11. Čermák J, Vítek A, Michalová K et al. Myelodysplastický syndrom v novém tisíciletí. Jak klasifikovat a léčit nemocné? Vnitř Lék 2005; 51: 20-30.

12. Ganser A, Hoelzer D. Clinical use of hematopoietic growth factors in the myelodysplastic syndromes. Semin Hematol 1996; 33: 186-195.

13. Greenberg P, Cox C, Le Beau MM et al. International scoring system for evaluation prognosis in myelodysplastic syndromes. Blood 1997; 89: 2079-2088.

14. Haselbeck A, Bailon P, Pahlke W et al. The discovery and characterization of CERA, an innovative agent for the treatment of anemia. Blood 2002; 100: 227a (abstr).

15. Harris NL, Jaffe ES, Diebold J et al. World Health Organization classification of neoplastic diseases of the hematopoietic and lymphoid tissues: report of the Clinical Advisory Committee Meeting - Airlie House, Virginia, November 1997. J Clin Oncol 1999; 17: 3835-3849.

16. Hellström-Lindberg E. Efficacy of erythropoietin in the myelodysplastic syndromes: a meta-analysis of 205 patients from 17 studies. Br J Haematol 1995; 89: 67-71.

17. Hellström-Lindberg E, Ahlgren T, Beguin Y et al. Treatment of anemia in myelodysplastic syndromes with granulocyte colony-stimulating factor plus erythropoietin: results from a randomized phase II study and long-term follow-up of 71 patients. Blood 1998; 92: 68-75.

18. Hellström-Lindberg E, Negrin R, Stein R et al. Erythroid response to treatment with G-CSF plus erythropoietin for the anaemia of patients with myelodysplastic syndromes: proposal for a predictive model. Br J Haematol 1997; 99: 344-351.

19. Hellström-Lindberg E, Gulbrandsen N, Lindberg G et al. A validated decision model for treating the anaemia of myelodysplastic syndromes with erythropoietin + granulocyte colony-stimulating factor: significant effects on quality of life. Br J Haematol 2003; 120: 1037-1046.

20. Italian Cooperative Study for rHuEpo in myelodysplastic syndromes: A randomized double-blind placebo-controlled study with subcutaneous recombinant human erythropoietin in patients with low-risk myelodysplastic syndromes. Br J Haematol 1998; 103: 1070-1074.

21. Koury MJ, Bondurant MC. Erythropoietin retards DNA breakdown and prevents programmed death in erythroid progenitor cells. Science 1990; 248: 378-381.

22. Mannone L, Gardin G, Quarre MC et al. High response rate to darbopoietin alfa in “low risk” MDS: results of a phase II study. Blood 2004; 104: 24a (abstr).

23. Miller AM, Noyes WE, Taetle R et al. Limited erythropoietic response to combined treatment with recombinant human interleukin 3 and erythropoietin in myelodysplastic syndrome. Leuk Res 1999; 23: 77-83.

24. Musto P, Falcone A, Sanpaolo G et al. Efficacy of a single, weekly dose of recombinant erythropoietin in myelodysplastic syndromes. Br J Haematol 2003; 122: 269-271.

25. Negrin RS, Stein R, Vardiman J et al. Treatment of the anemia of myelodysplastic syndromes using recombinant human granulocyte colony-stimulating factor in combination with erythropoietin. Blood 1993; 82: 737-743.

26. Seipelt G, Ottmann OG, Hoelzer D. Cytokine therapy for myelodysplastic syndrome. Curr Opin Hematol 2000; 7: 156-160.

27. Stein RS, Abels RI, Krantz SB. Pharmacologic doses of recombinant human erythropoietin in the treatment of myelodysplastic syndromes. Blood 1991; 78: 1658-1663.

28. Terpos E, Mougiou A, Kouraklis A et al. Prolonged administration of erythropoietin increases erythroid response rate in myelodysplastic syndromes: a phase II trial in 281 patients. Br J Haematol 2002; 118: 174-180.

29. Weiss G, Houston T, Kastner S et al. Regulation of cellular iron metabolism by erythropoietin: activation of iron-regulatory protein and upregulation of transferring receptor expression in erythroid cells. Blood 1997; 89: 680-687.

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