technetium-tc-99m-sulfur-colloid and Pancytopenia

Single-agent thalidomide (THAL) at "conventional" doses (> 100 mg/d) has been evaluated in myelofibrosis with myeloid metaplasia (MMM) based on its antiangiogenic properties and the prominent neoangiogenesis that occurs in MMM. THAL monotherapy at such doses produces approximately a 20% response rate in anemia but is poorly tolerated (an adverse dropout rate of > 50% in 3 months). To improve efficacy and tolerability, we prospectively treated 21 symptomatic patients (hemoglobin level < 10 g/dL or symptomatic splenomegaly) with MMM with low-dose THAL (50 mg/d) along with a 3-month oral prednisone (PRED) taper (beginning at 0.5 mg/kg/d). THAL-PRED was well tolerated in all enrolled patients, with 20 patients (95%) able to complete 3 months of treatment. An objective clinical response was demonstrated in 13 (62%) patients, all improvements in anemia. Among 10 patients who were dependent on erythrocyte transfusions, 7 (70%) improved and 4 (40%) became transfusion independent. Among 8 patients with thrombocytopenia (platelet count < 100 x 10(9)/L), 6 (75%) experienced a 50% or higher increase in their platelet count. In 4 of 21 patients (19%), spleen size decreased by more than 50%. Responses observed were mostly durable after discontinuation of the PRED. The dose of THAL in this study (50 mg/d) was better tolerated than the higher doses used in previous studies. Adverse events associated with corticosteroid therapy were mild and transient. Clinical responses did not correlate with improvements in either intramedullary fibrosis or angiogenesis. THAL-PRED is well tolerated and preliminarily appears to be a promising drug regimen for treating cytopenias in patients with MMM.

Topics: Adrenal Cortex Hormones; Aged; Anemia; Angiogenesis Inhibitors; Antineoplastic Agents, Hormonal; Antineoplastic Combined Chemotherapy Protocols; Female; Hematopoiesis, Extramedullary; Humans; Male; Middle Aged; Pancytopenia; Prednisone; Primary Myelofibrosis; Splenomegaly; Technetium Tc 99m Sulfur Colloid; Thalidomide; Treatment Outcome

Indium is generally presumed to localize in the bone marrow within the erythroid cell line. Fibrosis, inflammation, lymphoma, extended field radiation, chemotherapy, or combinations of both treatment modalities generally depress the uptake of indium by the marrow a complex fashion. We report a case of metastatic breast carcinoma and pancytopenia in which the In-111 scan appeared qualitatively similar to a Tc-99m MDP bone scan. Findings were confirmed by bone marrow biopsy.

Topics: Bone Marrow; Bone Neoplasms; Breast Neoplasms; Diphosphonates; Female; Humans; Indium; Middle Aged; Pancytopenia; Radioisotopes; Radionuclide Imaging; Technetium; Technetium Tc 99m Medronate; Technetium Tc 99m Sulfur Colloid

Topics: Adult; Anemia, Sickle Cell; Biopsy; Bone Marrow; Female; Fever; Humans; Mononuclear Phagocyte System; Necrosis; Pancytopenia; Radionuclide Imaging; Sulfur; Technetium; Technetium Tc 99m Sulfur Colloid