title: 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.
abstract: Treatment with erythropoietin (epo) may improve the anemia of myelodysplastic syndromes (MDS) in approximately 20% of patients. Previous studies have suggested that treatment with the combination of granulocyte colony-stimulating factor (G-CSF) and epo may increase this response rate. In the present phase II study, patients with MDS and anemia were randomized to treatment with G-CSF + epo according to one of two alternatives; arm A starting with G-CSF for 4 weeks followed by the combination for 12 weeks, and arm B starting with epo for 8 weeks followed by the combination for 10 weeks. Fifty evaluable patients (10 refractory anemia [RA], 13 refractory anemia with ring sideroblasts [RARS], and 27 refractory anemia with excess blasts [RAEB]) were included in the study, three were evaluable only for epo as monotherapy and 47 for the combined treatment. The overall response rate to G-CSF + epo was 38%, which is identical to that in our previous study. The response rates for patients with RA, RARS, and RAEB were 20%, 46%, and 37%, respectively. Response rates were identical in the two treatment groups indicating that an initial treatment with G-CSF was not neccessary for a response to the combination. Nine patients in arm B showed a response to the combined treatment, but only three of these responded to epo alone. This suggests a synergistic effect in vivo by G-CSF + epo. A long-term follow-up was made on 71 evaluable patients from both the present and the preceding Scandinavian study on G-CSF + epo. Median survival was 26 months, and the overall risk of leukemic transformation during a median follow-up of 43 months was 28%. Twenty patients entered long-term maintenance treatment and showed a median duration of response of 24 months. The international prognostic scoring system (IPSS) was effective to predict survival, leukemic transformation, and to a lesser extent, duration of response, but had no impact on primary response rates.
authors.affiliation: Department of Hematology, Huddinge University Hospital, Huddinge, Sweden. Eva.Hellstrom-Lindberg@medhs.ki.se
authors.forename: E
authors.initials: E
authors.lastname: Hellström-Lindberg
authors.forename: T
authors.initials: T
authors.lastname: Ahlgren
authors.forename: Y
authors.initials: Y
authors.lastname: Beguin
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: L
authors.initials: L
authors.lastname: Kanter-Lewensohn
authors.forename: O
authors.initials: O
authors.lastname: Linder
authors.forename: M
authors.initials: M
authors.lastname: Luthman
authors.forename: E
authors.initials: E
authors.lastname: Löfvenberg
authors.forename: H
authors.initials: H
authors.lastname: Nilsson-Ehle
authors.forename: J
authors.initials: J
authors.lastname: Samuelsson
authors.forename: J M
authors.initials: JM
authors.lastname: Tangen
authors.forename: I
authors.initials: I
authors.lastname: Winqvist
authors.forename: G
authors.initials: G
authors.lastname: Oberg
authors.forename: A
authors.initials: A
authors.lastname: Osterborg
authors.forename: A
authors.initials: A
authors.lastname: Ost
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000740:Anemia / Q000188:drug therapy* / Q000503:physiopathology*; D004359:Drug Therapy, Combination; D004921:Erythropoietin / Q000008:administration & dosage*; D005260:Female; D005500:Follow-Up Studies; D016179:Granulocyte Colony-Stimulating Factor / Q000008:administration & dosage*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009190:Myelodysplastic Syndromes / Q000503:physiopathology*; D016896:Treatment Outcome
chemical_list: D004921:Erythropoietin; D016179:Granulocyte Colony-Stimulating Factor