Advances in Supportive Care
Leukemia Insights - Summer 2007
Until recently most patients with MDS, particularly those with lower risk received only supportive care including platelet and red blood cell transfusions, and more recently the use of growth factors. Several new developments have emerged recently. First, the discovery that the combination of erythropoietin and neupogen not only has a synergistic effect on response5, but also may improve survival in patients with lower risk disease6. Another important issue relates to iron accumulation and its consequences in MDS. It is now emerging that iron disposition has an effect on the natural history of the disease and iron chelation may also improve survival7. We are currently studying several of these issues in MDS.
One of the most difficult problems in MDS is management of thrombocytopenia. Use of prior platelet growth factors has been associated with poor response rates and toxicities. We are now exploring the activity of the thrombomimetic agent AMG531 (protocol 2005-0577) in patients with thrombocytopenia with encouraging results.
Other studies at our center include studies with the oral iron chelation agents in MDS, the role of combination growth factors in MDS, and the use of a new formulation of ATG for patients with aplastic anemia and lower risk MDS.