A COMBINATION OF GRANULOCYTE-COLONY-STIMULATING FACTOR AND ERYTHROPOIETIN MAY SYNERGISTICALLY IMPROVE THE ANEMIA IN PATIENTS WITH MYELODYSPLASTIC SYNDROMES

In an attempt to obtain a synergistic effect on the hemoglobin levels in anaemic patients with myelodysplastic syndromes (MDS), granulocyte colony-stimulating factor (G-CSF) and erythropoietin (epo) were combin ed in a clinical phase II trial. Twenty-two patients with MDS were inc luded in the study. G-CSF was given alone for six weeks and then in co mbination with epo for the following twelve weeks. Eight (38%) of 21 e valuable patients showed a significant increase in hemoglobin. One pat ient with a previous response and subsequent failure to epo alone impr oved after the addition of G-CSF. Responses were more frequent in pati ents with less advanced pancytopenia, lower endogenous levels of serum -epo and in those with ring sideroblasts in the bone marrow. The respo nse frequency of 38% is higher than in any study of epo as monotherapy . Moreover, patients with ring sideroblasts, who respond poorly to epo alone, showed a response rate of 60%. Our findings suggest a synergis tic in vivo effect of granulocyte-CSF and erythropoietin in patients w ith myelodysplastic syndromes.