Hematologic responses of patients with MDS to antithymocyte globulin plus etanercept correlate with improved flow scores of marrow cells.
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.
Deeg
H Joachim
HJ
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
Jiang
Peter Y Z
PY
Holmberg
Leona A
LA
Scott
Bart
B
Petersdorf
Effie W
EW
Appelbaum
Frederick R
FR
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*
D000961:Antilymphocyte Serum; D007074:Immunoglobulin G; D018124:Receptors, Tumor Necrosis Factor; D000068800:Etanercept