J Korean Med Sci.  2006 Feb;21(1):40-45. 10.3346/jkms.2006.21.1.40.

The Hematologic Response to Anti-apoptotic Cytokine Therapy: Results of Pentoxifylline, Ciprofloxacin, and Dexamethasone Treatment for Patients with Myelodysplastic Syndrome

• Kim MK
• Lee JL
• Cho HS
• Bae SH
• Ryoo HM
• Lee KH
• Hyun MS

• KMID: 2157780
• DOI: http://doi.org/10.3346/jkms.2006.21.1.40

Abstract

TNF-alpha mediated apoptosis of the hematopoietic cells has been thought to contribute to the ineffective hematopoiesis observed in myelodysplastic syndrome (MDS). The combination of pentoxifylline (P) and ciprofloxacin (C) has been shown to reduce the serum levels of TNF-alpha, and an earlier trial of P and C with dexamethasone (D) provided good palliation for patients with MDS. The purpose of this study is to assess the hematologic response to PCD therapy for patients suffering with MDS. 21 of 25 patients who completed at least of 12 weeks of treatment were evaluable for the treatment efficacy. At baseline, the patient's median age was 60 yr (range: 18-75 yr). The diagnoses according to WHO classification included: RA (n=5), RCMD (n=10), RARS (n=1), RCMD/RS (n=1), RAEB (3), and CMML (n=1). 11 patients (52%) had at least single lineage response. 3 patients (11%) showed improvement of triple lineage cytopenia. There were no differences in the response rates between the FAB subtypes. The median time to response was 4 weeks (range: 2-12 weeks), and it is interesting that 9 of 11 patients who had a response remained without relapse for a median of 177 days (range: 78-634 days). These preliminary results indicate that anti-cytokine therapy with PCD is an effective and well tolerated palliative treatment for patients with MDS.

Keyword

Myelodysplastic Syndromes; Tumor Necrosis Factor-alpha; Apoptosis

MeSH Terms

Adolescent
Adult
Aged
Anti-Infective Agents/adverse effects/therapeutic use
Anti-Inflammatory Agents/adverse effects/therapeutic use
Apoptosis/*drug effects
Ciprofloxacin/adverse effects/therapeutic use
Comparative Study
Dexamethasone/adverse effects/therapeutic use
Drug Therapy, Combination
Erythrocyte Count
Female
Hematologic Agents/adverse effects/therapeutic use
Humans
Male
Middle Aged
Myelodysplastic Syndromes/*blood/drug therapy
Nausea/chemically induced
Pentoxifylline/adverse effects/therapeutic use
Platelet Count
Time Factors
Treatment Outcome
Tumor Necrosis Factor-alpha/*metabolism

Figure

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  Fig. 1 Graphic presentation of the hemoglobin levels and RBC requirements for the patients with a RBC response after PCD treatment.

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  Fig. 2 Graphic presentation of the platelet levels for the patients with a platelet response after PCD treatment.

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  Fig. 3 Graphic presentation of the neutrophil levels for the patients with a neutrophil response after PCD treatment.

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