Editorial Comment Acta Haematol 2015;134:135–137 DOI: 10.1159/000371833
Received: December 1, 2014 Accepted after revision: January 5, 2015 Published online: April 24, 2015
Immunosuppressive Therapy in Myelodysplastic Syndromes Is Still Alive Moshe Mittelman Howard S. Oster Department of Medicine, Tel Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
© 2015 S. Karger AG, Basel 0001–5792/15/1343–0135$39.50/0 E-Mail [email protected] www.karger.com/aha
in LR-MDS [2]. In a recent phase 2 trial treating erythropoietin-resistant LR-MDS patients with azacitidine alone or azacitidine plus erythropoietin, both treatments resulted in a very low response rate of 17% [12]. IST deserves more attention. On the basis of a similarity between severe aplastic anemia and hypoplastic MDS, and following observations that individual patients with hypoplastic MDS responded to IST, ATG was tested in nonrandomized phase 2 studies and in randomized phase 2 and 3 trials [3, 13–15]. Overall, erythroid response, with or without a response of other cell lines, especially platelets, was observed in 25–40% of patients without excess blasts, but only a few patients with RARS or RAEB responded to ATG [2, 3, 14, 16]. The response rate, however, depends largely on the population treated. ATG results are better in relatively young (
Received: December 1, 2014 Accepted after revision: January 5, 2015 Published online: April 24, 2015
Immunosuppressive Therapy in Myelodysplastic Syndromes Is Still Alive Moshe Mittelman Howard S. Oster Department of Medicine, Tel Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
© 2015 S. Karger AG, Basel 0001–5792/15/1343–0135$39.50/0 E-Mail [email protected] www.karger.com/aha
in LR-MDS [2]. In a recent phase 2 trial treating erythropoietin-resistant LR-MDS patients with azacitidine alone or azacitidine plus erythropoietin, both treatments resulted in a very low response rate of 17% [12]. IST deserves more attention. On the basis of a similarity between severe aplastic anemia and hypoplastic MDS, and following observations that individual patients with hypoplastic MDS responded to IST, ATG was tested in nonrandomized phase 2 studies and in randomized phase 2 and 3 trials [3, 13–15]. Overall, erythroid response, with or without a response of other cell lines, especially platelets, was observed in 25–40% of patients without excess blasts, but only a few patients with RARS or RAEB responded to ATG [2, 3, 14, 16]. The response rate, however, depends largely on the population treated. ATG results are better in relatively young (
