. 2010; 27(1): 1-7 | |||
Çocukluk yaşı akut myeloblastik lösemi ve myelodisplastik sendromunda myeloid lösemik hücrelerde farklılaşma ve apoptosisi sağlayan yüksek doz metilprednizolon ile yeni bir tedavi yaklaşımıGönül HiçsönmezHacettepe Üniversitesi Tıp Fakültesi Pediatrik Hematoloji BölümüAkut Promyelositik Lösemili (APL) çocuklarda, lösemik hücrenin normal hücreye dönüşünü (farklılaşma) sağlayan all-trans retinioik asidin (ATRA) kullanılması ile tedavi sonuçlarında önemli ilerlemeler elde edilmiştir. Bu nedenle APL dışında diğer akut myeloblastik lösemi (AML) subtiplerinde lösemik hücrelerin farklılaşmasını sağlayan ilaçların kullanılmsı, bu hastalar için de önemli ve ümit verici bir tedavi yaklaşımı olacaktır. Fare myeloid lösemik hücrelerin steroid ile farklılaşmasının sağlanabileceğini gösteren in vitro çalışmalara dayanarak, biz de, literatürde ilk defa olmak üzere, AML’li çocukların farklı subtiplerinde (AML M1,-M2,-M3,-M4,-M7), kısa süreli yüksek doz metilprednizolon (YDMP) tedavisi ile lösemik hücrelerin normal hücrelere dönebileceğini gösterdik. Ayrıca YDMP tedavisi, lösemik hücreden dönüşen veya direkt olarak myeloid lösemik hücrelerin apoptotik ölümüne neden olmaktadır. A novel approach to treatment in childhood acute myeloblastic leukemia and myelodysplastic syndrome with high-dose methylprednisolone as a differentiation- and apoptosis-inducing agent of myeloid leukemic cellsGönül HiçsönmezDepartment Of Hematology, İhsan Dogramacı Children’s Hospital, Hacettepe University Faculty Of Medicine, Ankara, TurkeyDifferentiation-inducing therapy with all-trans retinoic acid significantly improved the outcome in children with acute promyelocytic leukemia (APL). Therefore, use of agents that induce differentiation of leukemic cells in non-APL children appears to be a highly promising therapeutic approach. Based on the experimental studies in mice, we have shown that short-course high-dose methylprednisolone (HDMP) treatment can induce terminal differentiation of leukemic cells in children with various subtypes of acute myeloblastic leukemia (AML-M1,-M2,-M3,-M4,-M7). It has also been shown to induce apoptosis of myeloid leukemic cells with or without differentiation. Administration of HDMP as a single agent resulted in a rapid clinical improvement, a marked decrease in blast cells in both peripheral blood and bone marrow and dramatic decreases in the size of extramedullary leukemic mass in children with AML and myelodysplastic syndrome (MDS). Addition of HDMP to cytotoxic chemotherapy regimens increased the remission rate and improved the outcome in these children. Future clinical trials with HDMP would contribute to further improvements in the treatment results in these children. Keywords: High-dose methylprednisolone, differentiation, apoptosis, acute myeloblastic leukemia, myelodysplastic syndrome, childrenGönül Hiçsönmez. A novel approach to treatment in childhood acute myeloblastic leukemia and myelodysplastic syndrome with high-dose methylprednisolone as a differentiation- and apoptosis-inducing agent of myeloid leukemic cells. . 2010; 27(1): 1-7 Sorumlu Yazar: Gönül Hiçsönmez, Türkiye |
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