Mega-dose methylprednisolone (MDMP) for chronic idiopathic myelofibrosis / Kronik idiopatik miyelofibrosis icin yuksek doz metilprednizolon (YDMP).
|Publication:||Name: Turkish Journal of Hematology Publisher: Aves Yayincilik Audience: Academic Format: Magazine/Journal Subject: Health Copyright: COPYRIGHT 2010 Aves Yayincilik ISSN: 1300-7777|
|Issue:||Date: Dec, 2010 Source Volume: 27 Source Issue: 4|
To the Editor,
I would like to make few comments on Balci and her colleagues' paper entitled "Complex cytogenetic findings in the bone marrow of a chronic idiopathic myelofibrosis patient" which was published in the recent issue of the Journal. (1).
Although the authors' cytogenetic findings looks original, it should be considered that chronic idiopathic myelofibrosis (CIF) is a colonal disorder like chronic myeloid leukemia (CML), polycythemia vera, etc.
Among them only Philadelphia chromosome (Ph1) is specific for CML, but mutations are present in all of these clonal disorders. I believe since the cytogenetic changes are not pathognomic or specific, these kind of studies should be carried only on research basis. In addition to radiation as mentioned by the authors makes the interpretation of their findings more questionable.
On this occasion, I would specifically like to emphasize the MDMP treatment for these patients which seems to be the only approach in the treatment of this disorder. In addition to some stem cell transplantation reports, MDMP is cheap, safe and easily applicable in all conditions.
Although we first reported patient with CIF in 1957 from this country (2), we treated almost a dozen of CIF cases without major complications in children and adults since 1983 (3-13). MDMP treatment was mentioned in several occasions in this journal, we sorry that despite of its international consideration, except ITP treatment, my colleagues did not take it seriously (14).
We read the comments of Dr. Ozsoylu about our recently published case report titled "Complex cytogenetic findings in the bone marrow of a chronic idiopathic myelofibrosis patient". We would like to thank Dr, Ozsoylu very much for reminding us the importance of especially megadose methyl prednisolon for the treatment of different hematologic diseases.
Idiopathic myelofibrosis that is seen in adults is an incurable disease without allogeneic stem cell transplantation (1,2). Many kinds of therapies such as chemotherapeutics (3), (4) including busulfan, hydroxyurea, chlorambucil, 2-chlorodeoksiadenosamine; biologic response modifier regimens (5); corticosteroids, anabolic steroids (5), (6); thalidomide (7), (8), lenalidomide (9) have been used but none of them has changed the biology of the disease and survival rates of patients (10). Since there is no optimal therapy, the choice of the drug depends on the patient's characteristics and the physician's experience. Hydroxyurea was the drug of choice by the doctor who first saw him. When we met the patient, he was refractory to that therapy and had a very painful large spleen. Because of his comorbid conditions, splenic irradiation had been used to palliate his symptoms. The response was transient, as expected, and after a short period of time he died due to progressive disease.
Address for Correspondence: M.D. Sinasi Ozsoylu, Altunsehir Sitesi No.30, Beysukent, Ankara, Turkey Phone: +90 312 203 55 55 E-mail: firstname.lastname@example.org
M.D. Feride Iffet Sahin, Department of Medical Genetics, Baskent University Faculty of Medicine, Kubilay Sokak No:36 06570, Maltepe Ankara, Turkey
Tel: +90 312 232 44 00 - 302
Fax: +90 312 231 91 34
(1.) Balci TB, Yuksel MK, Yilmaz Z, Sahin FI. Complex cytogenetic findings in the bone marrow of a chronic idiopathic myelofibrosis patient. 2010;27:113-6.
(2.) Erman M, Ozsoylu S. Sur un cas d'anemie splenique erythromyeloide de l'adulte. La Presse Medicale 1957;65:1309-11.
(3.) Ozsoylu S, Ruacan S. High dose bolus methylprednisolone treatment for primary myelofibrosis. Eur J Pediatr 1983;140:810.
(4.) Ozsoylu S, Ruacan S. High-dose intravenous corticosteroid treatment in childhood idiopathic myelofibrosis. Acta Haematol 1986;75:49-51.
(5.) Ozsoylu S. Myelofibrosis with myeloid metaplasia. Blood 1986;67:253.
(6.) Ozsoylu S. High-dose intravenous methylprednisolone for idiopathic myelofibrosis. Lancet 1988;1:766.
(7.) Ozsoylu S. High-dose intravenous methylprednisolone for idiopathic myelofibrosis. Brit J Haematol 1988;70:388-9.
(8.) Ozsoylu S. Mega dose methylprednisolone (MDMP) treatment. Turk J Pediat 2004;46:292.
(9.) Ozsoylu S. Treatment of primary myelofibrosis. Turk J Hematol 2009;26:211-2.
(10.) Ozsoylu S. High dose intravenous methylprednisolone (HIVMP) in hematologic disorders. Hematology Reviews 1990;4:197-207.
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(13.) Megadose metilprednizolon; resyonal kortikosteroid kullanimi (Eds.Y Karaaslan, A Kadayifci) 2004;70:70-4.
(14.) Bernini JC, Carrillo JM, Buchanon GR. High-dose intravenous methylprednisolone therapy for patient with Diamond-Blackfan anemia refractory to conventional doses of prednisone. J Pediat 1995;127:654-9.
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