title: A prospective study of cyclosporine A treatment of patients with low-risk myelodysplastic syndrome: presence of CD55(-)CD59(-) blood cells predicts platelet response.
abstract: Although immunosuppressive therapy using antithymocyte globulin or cyclosporine A (CSA) is effective in selected patients with low-risk myelodysplastic syndrome, the response rates reported so far are inconsistent, and the indication of immunosuppressive therapy for myelodysplastic syndrome has not been clearly defined. We treated 20 myelodysplastic syndrome patients (17 refractory anemia cases [RA], 2 RA with excess blasts, and one RA with ringed sideroblasts) with 4 mg/kg per day of CSA for 24 weeks. Among the 19 patients evaluated, 10 showed hematologic improvement; 8 patients showed an erythroid response, 6 showed a platelet response, and one showed a neutrophil response. Most patients with hematologic improvement continued CSA thereafter, and the progressive response was observed until the latest follow-up (median, 30 months). Most toxicities associated with CSA usage were manageable, and no patient had developed acute leukemia up to this point. Short duration of illness, refractory anemia with minimal dysplasia determined by bone marrow morphology, and the presence of paroxysmal nocturnal hemoglobinuria-type cells were significantly associated with the platelet response. A minority of RA patients who did not possess such predictive variables achieved an isolated erythroid response. In conclusion, CSA may be a therapeutic option for patients with RA who do not have adverse prognostic factors.
authors: Department of Hematology and Oncology, Graduate School ofMedicine, Kyoto University, 54 Shogoin-Kawaracho, Sakyo-ku, Kyoto 606-8507, Japan. tishi@kuhp.kyoto-u.ac.jp
authors: Takayuki
authors: T
authors: Ishikawa
authors: Kaoru
authors: K
authors: Tohyama
authors: Shinji
authors: S
authors: Nakao
authors: Yataro
authors: Y
authors: Yoshida
authors: Masanao
authors: M
authors: Teramura
authors: Toshiko
authors: T
authors: Motoji
authors: Masaaki
authors: M
authors: Takatoku
authors: Mineo
authors: M
authors: Kurokawa
authors: Kinuko
authors: K
authors: Mitani
authors: Takashi
authors: T
authors: Uchiyama
authors: Mitsuhiro
authors: M
authors: Omine
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001792:Blood Platelets / Q000187:drug effects*; D018958:CD55 Antigens / Q000032:analysis; D018957:CD59 Antigens / Q000032:analysis; D016572:Cyclosporine / Q000008:administration & dosage* / Q000633:toxicity; D004906:Erythrocyte Count; D005260:Female; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D009190:Myelodysplastic Syndromes / Q000150:complications / Q000188:drug therapy*; D009504:Neutrophils / Q000166:cytology; D010976:Platelet Count; D011237:Predictive Value of Tests; D011379:Prognosis; D011446:Prospective Studies; D018570:Risk Assessment; D016896:Treatment Outcome
chemical_list: D018958:CD55 Antigens; D018957:CD59 Antigens; D007166:Immunosuppressive Agents; D016572:Cyclosporine