Immune treatments for myelodysplastic syndrome

Immune modulating drugs

The drugs thalidomide and lenalidomide (Revlimid^®) belong to the group of drugs known as immunomodulating drugs (or IMiDs). Thalidomide was used first in treating MDS. It helped some patients, but many people stopped taking the drug because of side effects. Lenalidomide is a newer drug that has fewer side effects.

Side effects include:

• Decreased blood counts (most often the white cell count and platelet count)
• Diarrhea or constipation
• Feeling tired and weak
• Pain in the hands and feet from nerve damage

Lenalidomide can also increase the risk of serious blood clots that start in the veins in the legs. Part of a clot can break off and travel to the lungs where it can cause problems with breathing or even death. Many experts feel that patients getting this drug should also get some kind of treatment to prevent blood clots.

Because of concern that these drugs could cause birth defects, these drugs are only available through programs run by the companies that make them.

Immunosuppression

Drugs that suppress or weaken the immune system can help some patients with MDS. A drug called anti-thymocyte globulin (ATG) has helped some people, usually younger ones, with MDS. It must be given in the hospital because it can sometimes cause severe allergic reactions leading to low blood pressure and problems breathing.

Another drug that works by suppressing the immune system is called cyclosporine. It was first used to block immune responses in people who have had organ or bone marrow transplants, but it has helped some patients with MDS. Side effects of cyclosporine include loss of appetite and kidney damage.