בדיקות-דם

ד"ר שלום. אבי בן 63 חולה בפרא-לוקמיה MDS .בבדיקת דם היום התקבלו התוצאות : WBC-2.05 RBC-2.19 HGB-7.0 PLT-24 HCT-22.8 במשך כ-4 חודשים 3 פעמים בשבוע הוזרק לו זריקות של" אפרס" ולקיחת כדורי ברזל. תוצאות בדיקת הדם שהתקבלו היום היו יותר נמוכות מקודמהם ונזקק ל-3 מנות דם. --האם ניתן לשפר את בדיקת הדם הנ"ל? -האם ישנו טיפול יותר ממוקד לסוג מחלה זו?(השתלה אינה באה בחשבון בגלל גילו). בתודה מראש רוני

לצערי הרב אין פתרון תרופתי למצבים אלה, וברוב המקרים טיפול כימותרפי עלול להחמיר את המצב. הטיפול במצב זה הוא טיפול תומך, קרי, מתן דם ותוצרי דם לפי הצורך. יש מקרים שבהם מתו דוראבולין יכול לסייע לפרק זמן מסויים, יש מקרים שבהם תרופה הנקראת דנאזול יכולה לסייע, או Amifostine . אבל עדיין, רוב המקרים אינם מראים שיפור משמעותי. אני מצרף כמה תקצירים מהעת האחרונה שאולי יוכלו לסייע. Leuk Lymphoma 2001 Jan;40(3-4):345-9 Amifostine in combination with erythropoietin and G-CSF promotes multilineage hematopoiesis in patients with myelodysplastic syndrome. Neumeister P, Jaeger G, Eibl M, Sormann S, Zinke W, Linkesch W Department of Internal Medicine, Karl-Franzens-University Graz, Austria. [email protected] [Medline record in process] Ineffective hematopoiesis leading to profound cytopenias represents a major clinical problem in the management of patients with myelodysplastic syndrome (MDS). The aminothiol amifostine has shown to promote multilineage hematopoiesis both in vivo and in vitro in patients with MDS. We have treated 10 patients with 250 mg/m2 amifostine thrice weekly in combination with erythropoietin for 4 consecutive weeks followed by 2 weeks observation. Responding patients received the same 6 week schedule, while nonresponder received G-CSF in addition to erythropoietin and amifostine during the second treatment course. All patients experienced single or multilineage hematologic improvement, but only 2 reached transfusion independency. Moreover, response was durable only in a minority of patients and thus additional studies are warranted to further define the potential interaction of amifostine and growth factors. Hematol 1999;4(2):91-112 Malignancy: Current Clinical Practice: Current Therapeutic Options in Myelodysplastic Syndromes. Hofmann WK, Hoelzer D Department of Hematology, Johann Wolfgang Goethe University Hospital, 60590 Frankfurt/Main, Germany. [Record supplied by publisher] Myelodysplastic syndromes (MDS) are characterized initially by ineffective hematopoiesis and subsequently the frequent development of acute myelogenous leukemias (AML). During the last 15 years, important progress has been made in the understanding of the biology and prognosis of myelodysplastic syndromes. Risk-adapted treatment strategies were established due to the high median age (60-75 years) of MDS-patients and the individual history of the disease (number of cytopenias, cytogenetical changes, transfusion requirements). The use of allogeneic bone marrow transplantation for MDS patients currently offers the only potentially curative treatment, but this treatment modality is not available for the most of the "typical" MDS-patients aged >60 years. Based on in-vitro findings analyzing the potential of several agents to differentiate or to stimulate hematopoietic progenitor cells a number of therapeutic options were evaluated in clinical trials: hematopoietic growth factors (e.g. erythropoietin, G-CSF), differentiation inducers (e.g. retinoids), or cytoprotective substances (amifostine). The role of immunsuppressive agents (antithymocyte globulin, cyclosporine A) either alone or in combination is being actively investigated. Using intensive cytotoxic treatment in patients with advanced MDS or AML after MDS complete remission rates comparable with those known from the treatment of de novo AML were reported. The therapy related toxicity (early death rate <10%) was reduced by using G-CSF given prior ("Priming") and/or after the cytotoxic treatment. Am J Hematol 2000 Aug;64(4):306-10 Prolonged complete remission of myelodysplastic syndrome treated with danazol, retinoic acid and low-dose prednisone. Sadek I, Zayed E, Hayne O, Fernandez L Department of Pathology, Dalhousie University, Queen Elizabeth II Health Science Centre, Halifax, Nova Scotia, Canada. [email protected] Myelodysplastic syndrome (MDS) is a diverse group of clonal hematologic neoplasms. Different medications have been tried in MDS; however, no effective treatment has been yet established. We report a patient with MDS who achieved a complete remission in response to combination therapy of danazol, retinoic acid, and prednisone. A 53-year-old female presented with pancytopenia, macrocytosis, and hypercellular bone marrow with erythroid hyperplasia and dysplasia and 10% ringed sideroblasts. Cytogenetic studies revealed the presence of two abnormal clones. She was diagnosed as having MDS-refractory anemia and was given blood transfusions to maintain blood cell counts at acceptable levels. At the same time, she was started on a combination of danazol (600 mg/day), retinoic acid (100 mg/day), and prednisone (10 mg every other day). Fourteen months later, the patient was in complete hematologic remission; she had normal peripheral blood count, and the blood smear showed normal morphology. Bone marrow studies revealed normal trilineage hematopoiesis. She was continued on the same combination treatment for 86 months, and she remained in complete clinical remission. Eighty-eight months from diagnosis, she relapsed with acute myeloid leukemia. This is the first reported case of MDS-RA that sustained a complete hematologic remission for a prolonged period in response to this combination treatment. This report indicates that restoration of normal hematopoiesis, prolongation of disease-free survival, and delay in the transformation to acute leukemia may be achieved by this combination of treatment in a subset of patients with MDS, especially refractory anemia with severe thrombocytopenia.