Interferon for Myeloproliferative disorders – pro

M Levin, MD — Mon, 27 Aug 2012 20:20:17 +0000

The myeloproliferative disorders consist of polycythemia vera, chronic myelogenous leukemia, agnogenic myeloid metaplasia, and essential thrombocythemia. All these disorders are thought to result from a hematopoietic stem cell lesion.

Interferon alfa is effective in suppressing bone marrow function in chronic myeloproliferative disorders, but this treatment requires multiple weekly injections. Pegylated interferon, on the other hand, can be given weekly. Several groups reported on the results of phase 2 trials of pegylated interferon alfa 2b in essential thrombocytosis and polycythemia vera with generally concordant results.Satisfactory platelet count reduction was achieved with 3 to 6 months of therapy in approximately 70% of patients, but the drug had to be discontinued in 15% to 52% of them because of side effects. In the one study in which marrow histology was examined, progression of myelofibrosis was not inhibited by pegylated interferon. The number of studies and quality of evidence meets Caremark criteria for approval. The therapy is not investigational and it is medically necessary.

Gugliotta L, Bulgarelli S, Tienghi A, et al. Bone marrow biopsy and aspirate evaluation in 90 patients with essential thrombocythemia treated with peg interferon alpha-2b. Preliminary results. Blood. 2004;104:11. Abstract 1523.

Samuelsson J, Hasselbalch H, Bruserud O, et al. A phase II trial of pegylated interferon alpha-2b in polycythemia vera and essential thrombocythemia: clinical responses, effects on PRV-1 expression and impact on quality of life. Blood. 2004;104:11. Abstract 1518.

Langer C, Lengfelder E, Thiele J, et al. Treatment with pegylated interferon alpha (Pegintron) for high-risk essential thrombocythemia: results of a phase II study. Blood. 2004;104:11. Abstract 1522.

Verstovsek S, Lawhorn K, Giles F, et al. PEG-intron for myeloproliferative diseases: an update on ongoing phase II study. Blood. 2004;104:11. Abstract 1517.

Interferon for hypereosinophilic syndrome

M Levin, MD — Wed, 20 Jun 2012 22:29:04 +0000

Chronic myeloproliferative disorders (CMPD) are classified according to the WHO classification of 2001 as polycythemia vera (PV), chronic idiopathic myelofibrosis (CIMF), essential thrombocythemia (ET), CMPD/unclassifiable (CMPD-U), chronic neutrophilic leukemia, and chronic eosinophilic leukemia (CEL)/hypereosinophilic syndrome, all to be delineated as different from another member of the group, BCR/ABL-positive chronic myeloid leukemia (CML). This article addresses specifically the rare hypereosinophilic syndrome.

Hypereosinophilic syndromes (HES) and systemic mastocytosis (SMCD) are a group of disorders with clinical symptoms from local and remote effects of excessive proliferation of eosinophils, a type of a blood cell and mast cells, respectively. Interferon alpha (IFN-alpha), alone or in combination with other medications, can be a useful, and at times life-saving, treatment for patients with HES. Receptors for IFN-alpha are present on eosinophils, and clinical benefits are due to its effect on eosinophil growth, movement, activation, and survival. These effects are likely mediated through multiple pathways, not all of which are known or understood. A number of case reports showed that IFN-alpha has been life-saving for patients with intractable HES that were resistant to prednisone, hydroxyurea, and other agents used for myeloproliferative syndromes. There are reports of its combined use with hydroxyurea and prednisone. There are also reports of the use of peg-interferon.

Unfortunately, HES is rare and prospective trials are not reasonable to expect. I did find that the PDQ from the National Cancer Institute recommended interferon for this disease.

Read the Professional version here.

Cancer Treatment Today » Myeloproliferative Disorders

Interferon for Myeloproliferative disorders – pro

Interferon for hypereosinophilic syndrome