Hi All!
Great conversation we are having introducing Marmab to our suite of peculiar diseases! I'm amazed at the collective knowledge of the subject.
Here's an abstract of a 2008 NIH study that looked back at folks with MDS who received ATG, Cyclosporine, or both.
The full range of MDSers were included -- various ages and risk levels, etc. -- though the bulk were INT-1.
30% of all patients responded to IST. Of those they found that only 8% responded to CSA alone (1 out of 13 patients), versus 24% to ATG alone (18 of 74 patients), and 48% (20 of 42) to ATG plus CSA.
This is looking back at folks that they had already decided to treat with IST, so it's not a random trial, but includes folks that the docs figured, for whatever reason, might respond. In other words, you can't read this data and figure that nearly half of MDSers are going to respond to IST. You can read it to say that ATG alone is about three times as effective as CSA alone, and ATG plus CSA is twice as good as ATG alone.
Of course, 8% did respond to just CSA. They didn't speculate on why the combo is better than either drug alone, though, given their rationale for Campath, one can surmise they think the combo knocks down the offending T-cells more completely and for a longer time than either drug alone.
Take care!
Greg
Quote:
Factors Affecting Response and Survival in Patients With Myelodysplasia Treated With Immunosuppressive Therapy
Elaine M. Sloand, Colin O. Wu, Peter Greenberg, Neal Young, and John Barrett
ABSTRACT
Purpose
Marrow failure in some patients with myelodysplastic syndrome (MDS) responds to immunosup- pressive treatment (IST), but long-term outcome after IST has not been described. We evaluated patients with MDS treated with IST at our institution to determine their clinical course compared with a comparable supportive care only group.
Patients and Methods
One hundred twenty-nine patients with MDS received IST with a median follow-up of 3.0 years (range, 0.03 to 11.3 years), using antithymocyte globulin (ATG) or cyclosporine (CsA) in combina- tion or singly. Variables affecting response and survival were studied and outcomes were compared with those of 816 patients with MDS reported to the International Myelodysplasia Risk Analysis Workshop (IMRAW) who received only supportive care.
Results
Thirty-nine (30%) of 129 patients receiving IST responded either completely or partially: 18 (24%) of 74 patients responded to ATG, 20 (48%) of 42 patients responded to ATG plus CsA, and one (8%) of 13 patients responded to CsA. Thirty-one percent (12 of 39) of the responses were complete, resulting in transfusion independence and near-normal blood counts. In multivariate analysis, younger age was the most significant factor favoring response to therapy. Other favorable factors affecting response were HLA-DR15 positivity and combination ATG plus CsA treatment (P .001 and P .048, respectively). In multivariate analysis of the combined IMRAW and IST cohorts, younger age, treatment with IST, and intermediate or low International Prognostic Scoring System score significantly favored survival.
Conclusion
IST produced significant improvement in the pancytopenia of a substantial proportion of patients with MDS and was associated with improved overall and progression-free survival, especially in younger individuals with lower-risk disease.
J Clin Oncol 26:2505-2511. © 2008 by American Society of Clinical Oncology
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