Most studies of immunosuppressive therapy (IST) in myelodysplastic syndromes (MDS) are limited by small numbers and the fact that they were conducted at a single center. They also report conflicting data regarding predictors for response to IST.
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With this in mind, a group of researchers recently gathered data from 15 centers in the United States and Europe to examine outcomes associated with IST and what might be the best predictors of which patients will benefit from the treatment.
“Years ago, Cleveland Clinic conducted a study showing patients with MDS benefited from immunosuppressive therapy,” says Mikkael Sekeres, MD, MS, of Cleveland Clinic Cancer Center. “Now we have much more data. This was the largest cohort of MDS patients ever collected who’ve been treated with immunosuppressive therapy.”
Dr. Sekeres was involved in the investigation, the results of which were published recently in Blood Advances.
Median survival: 47 months
The study included 207 patients; 63 percent were male. Median age at diagnosis was 65 years. Median follow-up time was 25.2 months. The most common IST regimen was anti-thymocyte globulin plus prednisone (43 percent).
Dr. Sekeres said the goal of the therapy was to stop the patients’ immune systems from attacking their bone marrow.
The overall response rate was 48.8 percent, including 11.2 percent that achieved a complete remission and 30 percent that achieved red blood cell transfusion independence.
“We found the overall response rate was almost 50 percent,” says Dr. Sekeres. “But more importantly, the duration of response was over a year and a half.”
In addition, the median overall survival was 47 months. And for those who achieved the response, the median overall survival wasn’t reached. However, researchers did not find any subgroups of patients who seemed to benefit from IST more than others.
Use IST more often
Dr. Sekeres said the results of this study are welcome news because they show there’s an additional way to treat patients with MDS.
“There are only three drugs approved for treatment of MDS,” he says. “So once you’ve exhausted those drugs, patients really have limited options.”
He said the data should convince more physicians to try IST with their MDS patients.
“We showed with a large cohort of patients that immunosuppressive therapy worked nearly half the time in patients with low-risk MDS,” he says. “What that means is that we should be using immunosuppressive therapy more frequently than we currently are.”