Cyclosporine A without or with Thalidomide for the Treatment of Patients with Myelodysplastic Syndromes.

The myelodysplastic syndromes (MDS) comprise a heterogeneous group of clonal hematopoietic stem cell disorders, while, immunological abnormalities are frequently observed in patients with MDS. Recently immunosuppressive therapies including prednisolone, antithymocyte globulin, and cyclosporin A (CsA) are used to treat cytopenia in some patients with MDS. Recent clinical trials have also confirmed that thalidomide may improve anemia and, less frequently, other cytopenias, in a proportion of younger patients with low-riskMDS (11–56%, on intention-to-treat analysis). In the current study, we report the outcome and side-effects in patients with MDS treated with cyclosporine A without or with thalidomide. From October 2000 to October 2005, 32 patients with MDS (RCMD 22 cases, RCMD-RARS 3 cases, RAEB-I6 cases, 5q- symdrome,1 case)were treated with cyclosporine A(CSA)(3mg/Kg.d) as single agents (n=14, group A) or CSA combined with thalidomide (200mg–400mg/d)(n=18, group B). There were no significant difference in hematologic or clinical features, Karyotype anomalies, classification of FAB or WHO, International Prognostic Scoring System(IPSS) score between the two group patients. Four patients of group A(28.5%) and twelve of group B (66.7%, P=0.011) achieved hematologic improvement. Three patients achieved a HI-E (three major), three patients HI-P(two major, one minor)and three patients HI-N(two major, one minor)within the group A. Twelve patients achieved a HI-E (eleven major, one minor), seven patients HI-P(five major, two minor)and six patients HI-N(three major, three minor)within group B. Two patients(2/11 cases,18.2%) became transfusion independence within group A, nine patients(9/14 cases, 64.3%)became transfusion independence within group B. There was statistic difference between two groups(P=0.021). Nine patients emerged hepatic lesion(three in group A(21.4%), six in group B(33.3%), P=0.457), Three patients emerged nephrotoxicity(one in group A(7.1%), two in group B(11.1%), P=0.702). These patients all made a recovery by treatment. Our primary results showed that CSA combined thalidomide is highly effective and relatively well-tolerated treatment for patients with MDS.