Erythropoietin in the treatment of patients with myelodysplastic syndrome

Česká verzia

Authors: J. Čermák
Authors place of work: Ústav hematologie a krevní transfuze, Praha, ředitel prof. MUDr. Pavel Klener, DrSc.
Published in the journal: Vnitř Lék 2005; 51(10): 1102-1107
Category: Original Contributions

Summary

Aim:
The aim of the study was to evaluate the indication of erythropoietin in patients with myelodysplastic syndrome (MDS).

Methods:
Twenty patients with MDS of RA or RARS subtype (according to the FAB classification) were treated with recombinant human erythropoietin (rHuEPO) in the dose of 150 IU/kg 3 times per week for 12 weeks, in 1 patient with profound granulocytopenia rHuEPO was combined with G-CSF in the dose of 300 μg 3 times per week. The criteria for complete response (CR) were achievement of Hb ≥ 115 g/l and transfusion independence, increase in Hb ≥ 15 g/l and transfusion independence were evaluated as a partial response (PR).

Results:
CR was observed in 4 patients (20 %), 4 patients (20 %) achieved PR. After exclusion of 3 patients in whom the favourable response to rHuEPO might be influenced by presence of incipient renal insufficiency, the CR + PR rate was 25 %. In 16 patients who responded to the treatment at least by increase in Hb ≥ 5 g/l or by decrease in the number of transfusions, the administration of rHuEPO was continued in the same dose for additional 12 weeks, nevertheless, no further CR or PR were observed after prolonged treatment. Concomitant administration of oral iron chelator deferiprone in the dose of 2 – 3 g/day in 5 patients with serum ferritin > 2000 μg/l resulted in 1 patient with PR to rHuEPO in a significant decrease of serum ferritin level and increase of urinary iron excretion. In 3 other patients with not sufficient response to rHuEPO a concomitant oral iron chelation enabled to stabilize serum ferritin level despite continuing iron load from red blood cell transfusions.

Conclusions:
Initial level of serum EPO < 100 IU/l, Hb > 85 g/l and dependence on administration of ≤ 2 TU red blood cell transfusions per month before starting treatment were predictive factors for response to rHuEPO administration. In patients with combination of these parameters, CR+ PR rate was 89 % suggesting that this subset of MDS patients with RA should be indicated for treatment with rHuEPO. Combination ot rHuEPO with G-CSF represents an expensive treatment approach and should be limited for patients with RARS, serum EPO < 500 IU/l and dependence on ≤ 2 TU of red blood cells transfusion per month.

Key words:
myelodysplastic syndrome – anemia – growth factors – erythropoietin – iron overload – chelation

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