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Good response to cyclosporine therapy in patients with myelodysplastic syndrromes having the HLA-DRB1*1501 allele

Leukemia volume 14, pages 344–346 (2000)Cite this article

The myelodysplastic syndromes (MDS) are clonal disorders originating from a pluripotent stem cell. Cytopenia is frequently observed in such patients. Because of the similarities between aplastic anemia (AA) and hypoplastic MDS, immunosuppressive therapies such as high-dose methylprednisolone, antithymocyte globulin (ATG), and cyclosporine (CyA), have also used to treat cytopenia of hypoplastic MDS, with response seen in two of five patients,1 likewise throughout 11 of 25 patients (44%),2 and 14 of 17 patitents (82%),3 respectively. Nakao et al4 reported that in the treatment of CyA for AA patients, the response rate to CyA in patients with DRB1*1501 (92%) was significantly higher than that in patients with DRB1*1502 (41%) and in patients with other DR alleles (57%). Therefore, we treated MDS patients with CyA to see whether the effectiveness of CyA treatment for MDS is associated with a patient's HLA-DRB1*1501 allele.

We treated nine patients with refractory anemia (RA) and one with RA with excess blasts (RAEB) with CyA. These patients were not responsive to conventional therapy, that is, anabolic steroid, corticosteroid, erythropoietin or granulocyte colony-stimulating factor therapy. The patients were diagnosed as having RA or RAEB according to FAB criteria, and chromosomal analysis was performed in all patients. CyA (50–300 mg/day) was administered to patients in whom anabolic steroids and small doses of prednisolone were usually used for a long time. However, those drugs and their doses were not changed before or after CyA treatment. Since aged patients tended to have side-effects of CyA, we started to treat patients with a low-dose CyA, 50 mg/day. Then, the treatment dose of CyA was increased to 200 or 300 mg/day, stepwise. Response criteria were defined as a resolution of all transfusion requirements and a ⩾2 g/dl increase in hemoglobin as compared with pretreatment levels. DNA was extracted from leukocytes in peripheral blood to determine a genotype of HLA-DRB1. DRB1 alleles were amplified using polymerase chain reaction and typed using the restriction fragment-length polymorphism method, which was performed by Shionogi Biomedical Laboratory (Osaka, Japan).

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References

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  1. Second Department of Internal Medicine, Hyogo College of Medicine, Hyogo, Japan

    T Okamoto, M Okada, S Yamada, H Takatsuka, H Wada, A Tamura, Y Fujimora, Y Takemoto & E Kakishita

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  1. T Okamoto
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  2. M Okada
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  3. S Yamada
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  4. H Takatsuka
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  5. H Wada
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  6. A Tamura
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  7. Y Fujimora
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  8. Y Takemoto
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  9. E Kakishita
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Okamoto, T., Okada, M., Yamada, S. et al. Good response to cyclosporine therapy in patients with myelodysplastic syndrromes having the HLA-DRB1*1501 allele. Leukemia 14, 344–346 (2000). https://doi.org/10.1038/sj.leu.2401665

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  • DOI: https://doi.org/10.1038/sj.leu.2401665

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