Prognostic markers of efficiency of immunosupressive therapy in patients with myelodysplastic syndrome

Authors

  • Ольга Ігорівна Бойко Academy of Medical Sciences of Ukraine» 45 General Chuprynka str., Lviv 79044, Ukraine, Ukraine
  • Звенислава Володимирівна Масляк State Institution «Institute of Blood Pathology and Transfusion Medicine, National Academy of Medical Sciences of Ukraine» 45 General Chuprynka str., Lviv, 79044, Ukraine, Ukraine
  • Звенислава Володимирівна Масляк State Institution «Institute of Blood Pathology and Transfusion Medicine, National Academy of Medical Sciences of Ukraine» 45 General Chuprynka str., Lviv, 79044, Ukraine, Ukraine
  • Ярослава Іллівна Виговська State Institution «Institute of Blood Pathology and Transfusion Medicine, National Academy of Medical Sciences of Ukraine» 45 General Chuprynka str., Lviv, 79044, Ukraine, Ukraine
  • Ярослава Іллівна Виговська State Institution «Institute of Blood Pathology and Transfusion Medicine, National Academy of Medical Sciences of Ukraine» 45 General Chuprynka str., Lviv, 79044, Ukraine, Ukraine
  • Мар’яна Іванівна Сімонова State Institution «Institute of Blood Pathology and Transfusion Medicine of National Academy of Medical Sciences of Ukraine» 45 General Chuprynka str., Lviv, 79044, Ukraine, Ukraine
  • Мар’яна Іванівна Сімонова State Institution «Institute of Blood Pathology and Transfusion Medicine of National Academy of Medical Sciences of Ukraine» 45 General Chuprynka str., Lviv, 79044, Ukraine, Ukraine
  • Наталія Яремівна Томашевська Faculty of Postgraduate Education Danylo Halytsky Lviv National Medical University 69 Pekarska str., Lviv, 79010, Ukraine, Ukraine
  • Наталія Яремівна Томашевська Faculty of Postgraduate Education Danylo Halytsky Lviv National Medical University 69 Pekarska str., Lviv, 79010, Ukraine, Ukraine

DOI:

https://doi.org/10.15587/2313-8416.2015.50513

Keywords:

myelodysplastic syndrome, cyclosporine A, cytokine, marrow

Abstract

Introduction: There is no “gold standard” of the treatment of myelodysplastic synfrom (MDS) for today. Use of the different directions of therapy at MDS is caused by the prognosis of clinical course, age and general state of patient, donor presence and possibility for an adequate attendant therapy. That is why the search of standards of treatment at MDS continues

Aim: To analyze an efficiency of the therapy with cyclosporine A in patients with MDS of the low risk and to detect the new prognostic factors of response to treatment.

Methods: 25 patients with MDS RA were examined according to FAB-classification, 15 women and 10 men whose mean age was 55 years. Statistical analysis of material was carried out using packages of applications STATISTICA for Windows 5,0 and NCSS. Parametric indicators were described as a median [lower-upper quartile] (minimum-maximum). The dynamics of parametric indicators in every group was assessed using Wilcoxon criterion.

Results: During the treatment with cyclosporine A the complete clinical and hematological remission was received in 28 % of patients, the partial remission was fixed in 25 % of patients and hematological improvement according to criteria of the system of International working group (IWG) – in 28 % of treated patients. It was revealed the reliable decrease of TNF-α, TGF-β and IL-6 in the process of treatment that prove the target mechanism of an effect of preparation at myelodysplastic syndrome. An influence of cytokines on the probability of positive result of treatment was not confirmed. It was established that the young age of patients, hypo- or normocellular marrow, an increased rate of lymphocytes in myelogram, an absence of hemotransfusion dependence and the level of hemoglobin higher than 80 g/l cause the better response to treatment with cyclosporine A. TNF-a concentration higher than 8 mg|ml is a marker of an early relapse in patients treated with cyclosporine A

Author Biographies

Ольга Ігорівна Бойко, Academy of Medical Sciences of Ukraine» 45 General Chuprynka str., Lviv 79044, Ukraine

Junior Research Associate of Hematology Department

State Institution «Institute of Blood Pathology and Transfusion Medicine, National

Звенислава Володимирівна Масляк, State Institution «Institute of Blood Pathology and Transfusion Medicine, National Academy of Medical Sciences of Ukraine» 45 General Chuprynka str., Lviv, 79044, Ukraine

Doctor of medical sciences, Head of Hematology

Department with Laboratory Group

Звенислава Володимирівна Масляк, State Institution «Institute of Blood Pathology and Transfusion Medicine, National Academy of Medical Sciences of Ukraine» 45 General Chuprynka str., Lviv, 79044, Ukraine

Doctor of medical sciences, Head of Hematology

Department with Laboratory Group

Ярослава Іллівна Виговська, State Institution «Institute of Blood Pathology and Transfusion Medicine, National Academy of Medical Sciences of Ukraine» 45 General Chuprynka str., Lviv, 79044, Ukraine

Doctor of medical sciences, Professor,

Chief Researcher 

Ярослава Іллівна Виговська, State Institution «Institute of Blood Pathology and Transfusion Medicine, National Academy of Medical Sciences of Ukraine» 45 General Chuprynka str., Lviv, 79044, Ukraine

Doctor of medical sciences, Professor,

Chief Researcher 

Мар’яна Іванівна Сімонова, State Institution «Institute of Blood Pathology and Transfusion Medicine of National Academy of Medical Sciences of Ukraine» 45 General Chuprynka str., Lviv, 79044, Ukraine

PhD, Senior Researcher

Hematology Department

Мар’яна Іванівна Сімонова, State Institution «Institute of Blood Pathology and Transfusion Medicine of National Academy of Medical Sciences of Ukraine» 45 General Chuprynka str., Lviv, 79044, Ukraine

PhD, Senior Researcher

Hematology Department

Наталія Яремівна Томашевська, Faculty of Postgraduate Education Danylo Halytsky Lviv National Medical University 69 Pekarska str., Lviv, 79010, Ukraine

PhD, Associate Professor

Hematology and Transfusiology Department 

Наталія Яремівна Томашевська, Faculty of Postgraduate Education Danylo Halytsky Lviv National Medical University 69 Pekarska str., Lviv, 79010, Ukraine

PhD, Associate Professor

Hematology and Transfusiology Department 

References

Greenberg, P. L., Stone, R. M., Bejar, R., Bennett, J. M., Bloomfield, C. D., Borate, U. et. al (2015). Myelodysplastic Syndromes, Version 2.2015. Featured updates to the NCCN Guidelines. JNCCN Journal of the National Comprehensive Cancer Network, 13 (3), 261–272.

Kastrinaki, M.-C., Pavlaki, K., Batsali, A. K., Kouvidi, E., Mavroudi, I., Pontikoglou, C., & Papadaki, H. A. (2013). Mesenchymal Stem Cells in Immune-Mediated Bone Marrow Failure Syndromes. Clinical and Developmental Immunology, 2013, 1–10. doi: 10.1155/2013/265608

Tomashevska, N. J., Vigovs’ka, J. I., Masliak, Z. V. (2007). Rol’ cytokiniv u patogenezi mielodysplastichnogo sindromu [The role of cytokines in the pathogenesis of Myelodysplastic Syndrome]. Ukrainckii zurnal hematologii I transfuziologii. Ukrainian journal of Haematology and transfusiology, 9 (2), 95–100.

Boehrer, S. (2008). Pathogenesis and targets in Myelodysplastic syndromes. Hematology (EHA Educ. Program), 76–82.

Barrett, A. J., Sloand, E. (2009). Autoimmune mechanisms in the pathophysiology of myelodysplastic syndromes and their clinical relevance. Haematologica, 94 (4), 449–451. doi: 10.3324/haematol.2009.006080

Skvorcov, V. V., Tumarenko, A. V., Skvorcov, E. M. (2009). Mielodisplastichni sindromi [Myelodysplastic syndromes]. Terapevticheskii arhiv. Therapeutic Archive, 8, 32–37.

Kasner, M. T., Luger, S. M. (2009). Update on the therapy for myelodysplastic syndrome. American Journal of Hematology, 84 (3), 177–186. doi: 10.1002/ajh.21352

Aggarwal, S., van de Loosdrecht, A. A., Alhan, C., Ossenkoppele, G. J., Westers, T. M., Bontkes, H. J. (2011). Role of immune responses in the pathogenesis of low-risk MDS and high-risk MDS: implications for immunotherapy. British Journal of Haematology, 153 (5), 568–581. doi: 10.1111/j.1365-2141.2011.08683.x

Risitano, A. M. (2010). Immunosuppressive therapies in the management of immune-mediated marrow failures in adults: where we stand and where we are going. British Journal of Haematology, 152 (2), 127–140. doi: 10.1111/j.1365-2141.2010.08439.x

Malcovati, L., Hellstrom-Lindberg, E., Bowen, D. et. al (2013). Diagnosis and treatment of primary myelodysplastic syndromes in adults: recommendations from the European LeukemiaNet. Blood, 122 (17), 2943–2964. doi: 10.1182/blood-2013-03-492884

Sloand, E. M., Wu, C. O., Greenberg, P., Young, N., Barrett, J. (2008). Factors Affecting Response and Survival in Patients With Myelodysplasia Treated With Immunosuppressive Therapy. Journal of Clinical Oncology, 26 (15), 2505–2511. doi: 10.1200/jco.2007.11.9214

Published

2015-09-28

Issue

Section

Medical