Document Detail

The use of selective immunosuppressive therapy on myelodysplastic syndromes in targeted populations results in good response rates and avoids treatment-related disease progression.
MedLine Citation:
PMID:  22038646     Owner:  NLM     Status:  MEDLINE    
To determine the treatment response and disease progression in strictly selected patients with myelodysplastic syndrome undergoing immunosuppressive therapy (IST), patients were required to have an international prognostic scoring system [corrected] (IPSS) score ≤ 1.0 and at least one of the following conditions: (1) expression of the HLA-DR15 allele, (2) bone marrow (BM) cellularity of less than 30%, and (3) abnormal immune index of BM T-lymphocytes.The exclusion criteria were as follows: (1) ≥ 5% marrow myeloblasts, (2) poor karyotype, and (3) diagnosis of concurrent nonhematological malignancy. Patients received antithymocyte globulin followed by cyclosporine A (CsA) or CsA alone for at least 3 months. Seventy-one cases were analyzed. The total response rate was 77.5% (55/71 cases) with 11 complete responses. The response rate was positively correlated with the number of recruitment criteria met. Patients with an abnormal CD8, an abnormal CD4, or both had similar response rates. Patients who responded to treatment had significantly lower Th1 and Tc1 levels after treatment (P < 0.01 and P < 0.001, respectively), and six of eight patients with abnormal chromosomes did not show obviously abnormal clonal expansion when reassessed after IST. During the median observation period of 24 months, only two cases exhibited disease progression. At the median observation of 24 months, 35 of 55 responders (63.6%) maintained a hematological response, and 60 of 71 patients (84.5%) were still alive. The strictly selective use of IST may yield high response rates and can avoid treatment-related acute myeloid leukemia transformation. IST significantly reduces Th1 and Tc1 levels without causing malignant clonal expansion.
Li Xiao; Zhu Qi; Chen Qiusheng; Xu Li; Song Luxi; Wu Lingyun
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Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't     Date:  2011-10-31
Journal Detail:
Title:  American journal of hematology     Volume:  87     ISSN:  1096-8652     ISO Abbreviation:  Am. J. Hematol.     Publication Date:  2012 Jan 
Date Detail:
Created Date:  2011-12-19     Completed Date:  2012-05-04     Revised Date:  2013-05-27    
Medline Journal Info:
Nlm Unique ID:  7610369     Medline TA:  Am J Hematol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  26-31     Citation Subset:  IM    
Copyright Information:
Copyright © 2011 Wiley Periodicals, Inc.
Hematology Division, The Sixth Hospital Affiliated to Shanghai Jiaotong University, People's Republic of China.
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MeSH Terms
Antibodies, Monoclonal, Humanized / therapeutic use*
Antilymphocyte Serum / therapeutic use*
Bone Marrow Cells / immunology
Cell Transformation, Neoplastic
Cyclosporine / therapeutic use*
Disease Progression
Immunosuppressive Agents / therapeutic use*
Leukemia, Myeloid, Acute / genetics,  immunology,  pathology
Middle Aged
Myelodysplastic Syndromes / drug therapy*,  genetics,  immunology,  mortality
T-Lymphocytes / immunology
Treatment Outcome
Young Adult
Reg. No./Substance:
0/Antibodies, Monoclonal, Humanized; 0/Antilymphocyte Serum; 0/Immunosuppressive Agents; 3A189DH42V/alemtuzumab; 59865-13-3/Cyclosporine
Erratum In:
Am J Hematol. 2012 Apr;87(4):452

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