Patients with myelodysplastic syndromes benefit from palliative therapy with amifostine, pentoxifylline, and ciprofloxacin with or without dexamethasone
Patients with myelodysplastic syndromes benefit from palliative therapy with amifostine, pentoxifylline, and ciprofloxacin with or without dexamethasone
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DOI：
10.1182/blood.v95.5.1580.005k45_1580_1587
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发表时间：
2000-03-01
期刊：
影响因子：
20.3
通讯作者：
Huang, RW
中科院分区：
文献类型：
--
作者：
Raza, A;Qawi, H;Huang, RW
35例骨髓增生异常综合征（MDS）患者登记在方案MDS 96-02中，并接受连续治疗，每日3次口服喷替茶碱800 mg和每日2次口服环丙沙星500 mg; 12周后，部分应答者和无应答者在方案中加入地塞米松，每日早晨口服4 mg，持续4周。氨磷汀以3个剂量水平（200 mg/M-2、300 mg/M-2和400 mg/M-2）每周3次静脉给药，每个队列10例患者。治疗已持续1年的反应。29人已完成至少12周的治疗，并可进行反应评估。在21名男性和8名女性（中位年龄67岁）中，20名患有难治性贫血（RA），3名患有RA伴环形铁粒幼细胞（RARS），5名患有RA伴原始细胞过多（RAEB），1名患有慢性粒单核细胞白血病（CMMoL）。5例继发性MDS，3个剂量水平之间的缓解率无差异。7例患者完全无应答，22例患者血细胞减少改善（76%），3例患者出现三系应答，10例患者出现双系应答，9例患者出现单系应答（9例患者中8例出现中性粒细胞绝对计数[ANC]，1例患者的红细胞输注量减少超过50%）。15名患者仅在添加地塞米松后才有反应，而7名患者在添加地塞米松前有反应。当按谱系检查时，22人中有19人显示ANC改善，22人中有11人显示输血减少50%以上，Hb水平改善或两者兼而有之，22人中有7人显示血小板计数改善。有趣的是，反应经常缓慢出现，并且在治疗12个月及以后观察到计数的持续改善。本研究支持了用细胞保护和抗细胞因子疗法的独特方法治疗MDS患者的可行性，以及当给予非细胞毒性药物时需要长期承诺治疗的原则。(C)2000年，美国血液学会。
Thirty-five patients with myelodysplastic syndrome (MDS) were registered on protocol MDS 96-02 and were receiving continuous therapy with pentoxifylline 800 mg 3 times a day and ciprofloxacin 500 mg twice a day by mouth; dexamethasone was added to the regimen for the partial responders and the nonresponders after 12 weeks at a dose of 4 mg by mouth every morning for 4 weeks. Amifostine was administered intravenously 3 times a week at 3 dose levels (200 mg/M-2, 300 mg/M2, and 400 mg/M-2) to cohorts of 10 patients each. Therapy has been continued for 1 year in responders. Twenty-nine have completed at least 12 weeks of therapy and are available for response evaluation. Of the 21 men and 8 women (median age, 67 years), 20 had refractory anemia (RA), 3 had RA with ringed sideroblasts (RARS), 5 had RA with excess blasts (RAEB), and 1 had chronic myelomonocytic leukemia (CMMoL). Five had secondary MDS, No differences were noted in response rates among the 3 dose levels. Seven patients did not respond at all, and 22 showed an improvement in cytopenias (76%), Three had a triple lineage response, 10 had a double lineage response, and 9 had a single lineage response (8 of 9 in absolute neutrophil count [ANC] and 1 had more than a 50% reduction in packed red blood cell transfusions). Fifteen patients responded only after the addition of dexamethasone, whereas 7 responded before. When examined by lineage, 19 of 22 showed improved ANC, 11 of 22 demonstrated more than 50% reduction in blood transfusions, improved Hb levels, or both, and 7 of 22 showed improvement in platelet counts. Interestingly, the responses were frequently slow to appear, and continued improvement in counts was seen up to 12 months of therapy and beyond. This study supports the feasibility of treating patients with MDS with the unique approach of cytoprotection and anticytokine therapies as well as the principle that prolonged commitment to treatment is desirable when noncytotoxic agents are administered. (C) 2000 by The American Society of Hematology.