title: A combination of granulocyte colony-stimulating factor and erythropoietin may synergistically improve the anaemia in patients with myelodysplastic syndromes.
abstract: In an attempt to obtain a synergistic effect on the hemoglobin levels in anaemic patients with myelodysplastic syndromes (MDS), granulocyte colony-stimulating factor (G-CSF) and erythropoietin (epo) were combined in a clinical phase II trial. Twenty-two patients with MDS were included in the study. G-CSF was given alone for six weeks and then in combination with epo for the following twelve weeks. Eight (38%) of 21 evaluable patients showed a significant increase in hemoglobin. One patient with a previous response and subsequent failure to epo alone improved after the addition of G-CSF. Responses were more frequent in patients with less advanced pancytopenia, lower endogenous levels of serum-epo and in those with ring sideroblasts in the bone marrow. The response frequency of 38% is higher than in any study of epo as monotherapy. Moreover, patients with ring sideroblasts, who respond poorly to epo alone, showed a response rate of 60%. Our findings suggest a synergistic in vivo effect of granulocyte-CSF and erythropoietin in patients with myelodysplastic syndromes.
authors.affiliation: Department of Medicine, Huddinge University Hospital, Stockholm, Sweden.
authors.forename: E
authors.initials: E
authors.lastname: Hellström-Lindberg
authors.forename: G
authors.initials: G
authors.lastname: Birgegård
authors.forename: M
authors.initials: M
authors.lastname: Carlsson
authors.forename: J
authors.initials: J
authors.lastname: Carneskog
authors.forename: I M
authors.initials: IM
authors.lastname: Dahl
authors.forename: I
authors.initials: I
authors.lastname: Dybedal
authors.forename: G
authors.initials: G
authors.lastname: Grimfors
authors.forename: K
authors.initials: K
authors.lastname: Merk
authors.forename: J M
authors.initials: JM
authors.lastname: Tangen
authors.forename: I
authors.initials: I
authors.lastname: Winqvist
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000753:Anemia, Refractory / Q000628:therapy*; D000754:Anemia, Refractory, with Excess of Blasts / Q000628:therapy*; D004357:Drug Synergism; D004359:Drug Therapy, Combination; D004921:Erythropoietin / Q000008:administration & dosage* / Q000009:adverse effects; D005260:Female; D016179:Granulocyte Colony-Stimulating Factor / Q000008:administration & dosage* / Q000009:adverse effects; D006801:Humans; D008297:Male; D008875:Middle Aged
chemical_list: D004921:Erythropoietin; D016179:Granulocyte Colony-Stimulating Factor