Stadler M, Germing U, Kliche K-O, Josten K M, Kuse R, Hofmann W-K, Schrezenmeier H, Novotny J, Anders O, Eimermacher H, Verbeek W, Kreipe H-H, Heimpel H, Aul C, Ganser A
Department of Haematology and Oncology, Medizinische Hochschule, Hannover, Germany.
Leukemia. 2004 Mar;18(3):460-5. doi: 10.1038/sj.leu.2403239.
Immunosuppression has recently been proposed for low-risk myelodysplastic syndromes (MDS) to reverse bone marrow failure by inhibiting intramedullary secretion of proapoptotic cytokines. We treated 35 MDS patients (24 refractory anaemia (RA), 10 RA with excess blasts and one chronic myelomonocytic leukaemia) with either horse antithymocyte globulin 15 mg/kg/day or rabbit antithymocyte globulin 3.75 mg/kg/day, each for 5 days. Median age was 63 years (range: 41-75). After 1 to 34+ months of follow-up (mean: 15+), four patients experienced complete haematological responses (CR), six good responses (GR) and two minor responses. All CRs and GRs occurred in patients with RA, in whom both horse and rabbit ATG yielded five responses out of 12 (42%). Time to response varied between 1 and 10 (mean: 3) months. The median duration of response was 9+ (1-17+) months; five patients are in continuing response. In all, 23 patients suffered side effects > degrees II WHO (the degree of toxicity encountered according to the internationally accepted WHO toxicity grading); one patient died 2 weeks after rabbit ATG from rhinocerebral mucormycosis. Parameters that correlated with response were duration of disease and RA subgroup. In our experience, immune-modulating therapy with either horse or rabbit ATG is feasible in patients with RA and short duration of disease.
最近有人提出对低危骨髓增生异常综合征（MDS）进行免疫抑制治疗，通过抑制骨髓内促凋亡细胞因子的分泌来逆转骨髓衰竭。我们用马抗胸腺细胞球蛋白15mg/kg/天或兔抗胸腺细胞球蛋白3.75mg/kg/天治疗了35例MDS患者（24例难治性贫血（RA）、10例伴有过多原始细胞的RA和1例慢性粒单核细胞白血病），每种药物均使用5天。中位年龄为63岁（范围：41 - 75岁）。经过1至34 +个月的随访（平均：15 +），4例患者出现完全血液学缓解（CR），6例出现良好缓解（GR），2例出现轻微缓解。所有CR和GR均发生在RA患者中，马抗胸腺细胞球蛋白和兔抗胸腺细胞球蛋白在12例患者中均产生了5例缓解（42%）。缓解时间在1至10个月之间（平均：3个月）。缓解的中位持续时间为9 +（1 - 17 +）个月；5例患者仍处于持续缓解状态。共有23例患者出现> WHO二级的副作用（根据国际公认的WHO毒性分级所遇到的毒性程度）；1例患者在接受兔抗胸腺细胞球蛋白治疗2周后死于鼻脑毛霉菌病。与缓解相关的参数是疾病持续时间和RA亚组。根据我们的经验，用马抗胸腺细胞球蛋白或兔抗胸腺细胞球蛋白进行免疫调节治疗在疾病持续时间短的RA患者中是可行的。
