Treatment of advanced myelodysplastic syndrome with a regimen including recombinant human granulocyte colony-stimulating factor preceding allogeneic bone marrow transplantation

We treated 13 patients with morphologically advanced myelodysplastic syndrome using cytosine arabinoside and total body irradiation, followed by allogeneic marrow transplantation from HLA-identical sibling donors. Granulocyte colony-stimulating factor (G-CSF) was added to the preparative regimen to selectively increase chemosensitivity of leukaemic cells and to improve transplant outcome. No regimen-related deaths occurred, and no side- effects related to the addition of G-CSF were observed except for transient mild bone pain. At a median follow-up time of 39 months the projected 5-year disease-free survival and 5-year overall survival were 67.7% and 75.5%, respectively, with only one case showing cytogenetic relapse. The preparative regimen including G-CSF is feasible, and preliminary results seem to be encouraging. However, a larger trial is clearly warranted to evaluate its efficacy.