Thalidomide, stanozolol combined with prednisone for improvement of the related hematologic adverse reactions of ruxolitinib in patients with myelofibrosis

Abstract

Objective To analyze the clinical effects and safety of combination treatment of thalidomide, stanozolol, and prednisone (TSP regimen) in patients with myelofibrosis (MF) who experienced hematological adverse reactions during ruxolitinib treatment. Methods Ten MF patients with anemia or thrombocytopenia during ruxolitinib treatment from January 2016 to July 2017 in Peking Union Medical College Hospital were retrospectively analyzed. All patients were treated with a combination of low dose of thalidomide (around 75 mg/d), stanozolol (2 mg/time, 3 times per day), and low dose of prednisone (0.5 mg·kg-1·d-1). The hematological response and safety were assessed. Results There were 9 cases of anemia and 7 cases of thrombocytopenia during ruxolitinib treatment. After TSP regimen treatment, there were 5 cases of hemoglobin response including 1 case of complete remission (CR). There were 4 cases of platelet response and all achieved CR. Totally, the hematological overall response was seen in 7 cases. The median time from taking medicine to getting response was 27 d (13-89 d). 3 patients lost efficacy, while the median duration of response didn't reach (28-207 d). Conclusion TSP regimen can improve anemia or thrombocytopenia during ruxolitinib treatment in patients with MF. Key words: Myelofibrosis; Drug therapy, combination; Thalidomide; Stanozolol; Prednisone; Ruxolitinib