Recombinant human erythropoietin in combined treatment with granulocyte- or granulocyte-macrophage colony-stimulating factor in patients with myelodysplastic syndromes

摘要

Purpose: Myelodysplastic syndromes (MDS)nare a heterogeneous group of hemopoietic progenitorncell disorders, and patients with MDS regularly developnanemia and frequently become transfusion-dependent.nTreatment with erythropoietin (EPO) has been tried toncorrect anemia with only limited success with responsenrates ranging from 16% to 25%. However, it isnbecoming evident that the generally rather low responsenrate of EPO inpatien ts with MDS will be improved bynthe combination of EPO with either G-CSF ornGM-CSF. Method: Here, we analyzed the results fromnthe literature (six papers and one abstract using EPOnplus G-CSF, and seven papers using EPO plusnGM-CSF). Results: Among all trials the cytokine dosenand schedule varied, and the response criteria were notnuniform. The average response rate for improvingnanemia was 41% in 207 patients treated with EPO andnG-CSF, and 26% in 154 patients treated with EPO andnGM-CSF. There were higher response rates for refractorynanemia (RA) (45%), ringed sideroblastsn(RARS) (47%), and excess of blasts (RAEB) (38%)ncompared with blasts intran sformation (RAEBT)n(17%) for the treatment with EPO plus G-CSF. Thencorresponding response rates for treatment with EPOnplus GM-CSF were 30% (RA), 29% (RARS), 16%n(RAEB), and 0% (RAEBT), respectively. Prolongednadministration even showed a higher increment in thenresponse rates. Conclusion: In conclusion, the combinationnof EPO with G-CSF is probably superior tonEPO plus GM-CSF. There seems to be a positivencorrelation between the duration of cytokine treatmentnand response rates, and higher response rates in earlynMDS stages compared to advanced entities. However,ncontrolled studies are mandatory to evaluate the rolenof the combined cytokine treatment in patients withnMDS.