COMBINATION THERAPY WITH RECOMBINANT-HUMAN-ERYTHROPOIETIN, INTERFERON-ALPHA-2B AND GRANULOCYTE-MACROPHAGE COLONY-STIMULATING FACTOR IN IDIOPATHIC MYELOFIBROSIS

Seven patients, 3 men and 4 women 48-72 years of age and suffering fro m idiopathic myelofibrosis were given a combination of recombinant hum an erythropoietin (r-hu-Epo), interferon-alpha-2b (IFN) and GM-CSF, in an attempt to treat their pancytopenia and marrow fibrosis. The dose of r-hu-Epo was 200 U/kg 3 times weekly, that of IFN was 3 x 10(6)/U 3 times weekly, and that of GM-CSF was 250 mu g/m(2)/daily. The duratio n of therapy ranged from 3 to 6 months for r-hu-Epo and IFN and was 3 weeks for GM-CSF. The treatment regimen had a beneficial effect on all patients. The levels of hemoglobin increased in all patients but part icularly in 5 (2 of whom had been dependent on red blood cell transfus ions). Splenomegaly decreased significantly in 4 patients. Fibrosis in the bone marrow decreased in 2 patients. Three patients also had an i ncrease in the number of white blood cells during the therapy with GM- CSF. We observed mild side effects in 6 of our patients. One patient h ad severe side effects from IFN and treatment was discontinued. In con clusion, the combination of r-hu-Epo, IFN and GM-CSF may improve the a nemia (due to r-hu-Epo), increase the white blood cell count (due to G M-CSF) and reduce the marrow fibrosis (probably due to IFN) in patient s with idiopathic myelofibrosis.