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Myelodysplastic syndromes (MDS) are included into a heterogeneous group of clonal blood diseases characterized by peripheral cytopenias, dysplastic features of hematopoietic precursors, progressive deterioration and a high risk of transformation into leukemia. MDS occur in several versions that differ in frequency of appearance, the duration of the course and the probability of transformation into acute leukemia. The choice of therapy for a particular patient is determined by the morphological variant of the disease, the prognostic group, age and comorbidity. In hypoplastic cases of MDS are often used immunosuppressive therapy.

Analysis of the effectiveness of immunosuppressive therapy in patients with primary MDS

The research included 19 patients with primary MDS from 22 to 58 years (median age 46 years, 11 male, 8 female). The diagnosis was made according to the criteria of the WHO classification of myeloid neoplasms in 2008. The materials were taken only after signing by patients informed consent form to participate in the research. The calculations are performed in the R version 3.1.3 statistical package.

There were patients with defined MDS subtypes: RA in 52,6 %, RCMD in 31,6 and RAEB in 15,8%. Hypoplastic form of MDS were diagnosed in 63,2% patients. The increased number of lymphocytes in the bone marrow of patients were 52,6%, accumulation of lymphocytes in the bone marrow biopsy – in 36,8%. Cytogenetic abnormalities were found in 21% of patients (in 5,3% complex and in 15,7% isolated). All patients used immunosuppressive therapy as a first-line treatment: Antithymocyte globulin and Cyclosporine A (CsA) in 15,8%, monotherapy with CsA in 84,2%. CsA therapy started at a dose of 5 mg/kg per day. Dose correction performed depending on the concentration of CsA in the serum and toxicity. Median treatment was 143 days (36…1253 days). The response rate to CsA treatment was considered a complete remission (normalization of blood and bone marrow), partial remission (improvement of blood counts for more than 50% and no dependence on transfusions of blood components) or improvement (reduction in transfusion requirements by 50% or more). Complete remission was achieved in 10,5% of patients (only variant RA). Partial remission was obtained in 31,6% (variants RA and RCMD) and improvement in 36,8% (variants RA, RCMD and RAEB). There was no response to treatment in 21,1% of patients (variants RCMD and RAEB). Positive effect on immunosuppressive therapy significantly more likely achieved in patients with hypoplastic forms MDS (57,9%) and the presence of clusters of lymphocytes in the bone marrow biopsies (36,8%). Dependence of treatment efficiency and cytogenetic abnormalities not detected.

The effectiveness of immunosuppressive therapy in MDS associated with a variant of the disease, bone marrow cellularity and the bone marrow lymphoid infiltration. The greatest effect of the immunosuppressive therapy can be expected in patients with hypoplastic MDS and accumulation of lymphocytes in the bone marrow biopsy.