title: Hematologic responses of patients with MDS to antithymocyte globulin plus etanercept correlate with improved flow scores of marrow cells.
abstract: Myelodysplastic syndrome (MDS) comprises a spectrum of heterogeneous diseases. Most patients present with ineffective hematopoiesis. The pathophysiology involves immune-mediated effects, cytokine dysregulation, and apoptosis, among others. We treated 14 transfusion-requiring patients with MDS, 10 with refractory anemia (RA) and four with RA with excess blasts (RAEB) with a 4-day course of antithymocyte globulin (ATG) followed by intermittent etanercept for 4 months. Among 13 evaluable patients, five are red blood cell and platelet transfusion independent for intervals extending beyond 2 years, and two have normalized their peripheral blood parameters. One additional patient showed a transient rise of platelet and neutrophil counts, for an overall response rate of 46%. Responding patients showed striking improvements in marrow cell abnormalities as characterized by flow cytometry. These data show that a combination of ATG plus etanercept offers effective palliative therapy for unselected patients with MDS. Further trials incorporating these two agents are warranted.
authors.affiliation: Division of Clinical Research, Fred Hutchinson Cancer Research Center, 1100 Fairview Avenue N., D1-100, PO Box 19024, Seattle, WA 98109-1024, USA. jdeeg@fhcrc.org
authors.forename: H Joachim
authors.initials: HJ
authors.lastname: Deeg
authors.forename: Peter Y Z
authors.initials: PY
authors.lastname: Jiang
authors.forename: Leona A
authors.initials: LA
authors.lastname: Holmberg
authors.forename: Bart
authors.initials: B
authors.lastname: Scott
authors.forename: Effie W
authors.initials: EW
authors.lastname: Petersdorf
authors.forename: Frederick R
authors.initials: FR
authors.lastname: Appelbaum
mesh_terms: D000961:Antilymphocyte Serum / Q000627:therapeutic use*; D000068800:Etanercept; D006801:Humans; D007074:Immunoglobulin G / Q000627:therapeutic use*; D009190:Myelodysplastic Syndromes / Q000188:drug therapy / Q000473:pathology / Q000628:therapy*; D010865:Pilot Projects; D018124:Receptors, Tumor Necrosis Factor / Q000627:therapeutic use*
chemical_list: D000961:Antilymphocyte Serum; D007074:Immunoglobulin G; D018124:Receptors, Tumor Necrosis Factor; D000068800:Etanercept