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The use of immunosuppressive therapy for the treatment of myelodysplastic syndromes (MDS) is currently being investigated. Immunosuppressive therapy with anti-thymocyte globulin (ATG), cyclosporin A, or a combination of these two drugs, has shown promise in a limited number of studies. Treatment with immunosuppressive drugs may be considered an alternative in patients with MDS for whom bone marrow transplantation is not an option.

Thalidomide is another drug that has been shown to have immunosuppressive properties. One study reported that patients with myelodysplastic syndromes who were treated with thalidomide no longer required blood transfusions. In this study, low-risk MDS patients with no increase in blast counts and higher platelet levels before treatment with thalidomide responded more favorably to thalidomide therapy. Thalidomide, however, frequently produces troublesome side-effects including:

• Constipation
• Drowsiness
• Peripheral neuropathy (a nervous system disorder that causes numbness, tingling, burning, or weakness in the hands and/or feet)

A potential drawback of immunosuppressive therapy is that it may induce chromosomal abnormalities or may accelerate leukemic transformation in MDS patients. For these reasons, researchers are continuing to investigate the potential risks and benefits of immunosuppressive therapy for the management of patients with myelodysplastic syndromes.

Revlimide is another immunomodulatory agent that is attracting considerable attention. It has fewer side effects than thalidomide and appears to decrease red blood cell transfusion requirements in a considerable number of patients, particularly those with abnormalities of the long arm of chromosome 5 ("5q-syndrome").