{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,4]],"date-time":"2026-07-04T15:51:13Z","timestamp":1783180273298,"version":"3.54.6"},"reference-count":36,"publisher":"American Society of Clinical Oncology (ASCO)","issue":"3","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCO"],"published-print":{"date-parts":[[2011,1,20]]},"abstract":"<jats:sec><jats:title>Purpose<\/jats:title><jats:p> Immunosuppressive treatment is reported to improve cytopenia in some patients with myelodysplastic syndrome (MDS). Combined antithymocyte globulin (ATG) and cyclosporine (CSA) is most effective in patients with immune-mediated marrow failure. <\/jats:p><\/jats:sec><jats:sec><jats:title>Patients and Methods<\/jats:title><jats:p> This trial was designed to assess the impact of immunosuppression on hematopoiesis, transfusion requirements, transformation, and survival in patients with MDS randomly assigned to 15 mg\/kg of horse ATG for 5 days and oral CSA for 180 days (ATG+CSA) or best supportive care (BSC), stratified by treatment center and International Prognostic Scoring System (IPSS) risk score. Primary end point was best hematologic response at 6 months. Eligible patients had an Eastern Cooperative Oncology Group performance status of \u2264 2 and transfusion dependency of less than 2 years in duration. <\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p> Between 2000 and 2006, 45 patients received ATG+CSA (median age, 62 years; range, 23 to 75 years; 56% men) and 43 patients received BSC (median age, 65 years; range, 24 to 76 years; 81% men). IPSS score was low, intermediate-1, intermediate-2, high, and not evaluable in eight, 24, seven, one, and five patients on ATG+CSA, respectively, and eight, 25, five, zero, and five patients on BSC, respectively. Refractory anemia, refractory anemia with ringed sideroblasts, refractory anemia with excess of blasts (RAEB) -I, RAEB-II, and hypoplastic disease were present in 21, six, nine, zero, and nine patients on ATG+CSA, respectively, and 18, eight, 11, two, and four patients on BSC, respectively. By month 6, 13 of 45 patients on ATG+CSA had a hematologic response compared with four of 43 patients on BSC (P = .0156). Two-year transformation-free survival (TFS) rates were 46% (95% CI, 28% to 62%) and 55% (95% CI, 34% to 70%) for ATG+CSA and BSC patients, respectively (P = .730), whereas overall survival (OS) estimates were 49% (95% CI, 31% to 66%) and 63% (95% CI, 42% to 78%), respectively (P = .828). <\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p> This open-label randomized phase III trial demonstrates that ATG+CSA treatment seems to be associated with hematologic response in a subset of patients without apparent impact on TFS and OS. <\/jats:p><\/jats:sec>","DOI":"10.1200\/jco.2010.31.2686","type":"journal-article","created":{"date-parts":[[2010,12,14]],"date-time":"2010-12-14T04:46:48Z","timestamp":1292302008000},"page":"303-309","source":"Crossref","is-referenced-by-count":161,"title":["Immunosuppressive Therapy for Patients With Myelodysplastic Syndrome: A Prospective Randomized Multicenter Phase III Trial Comparing Antithymocyte Globulin Plus Cyclosporine With Best Supportive Care\u2014SAKK 33\/99"],"prefix":"10.1200","volume":"29","author":[{"given":"Jakob R.","family":"Passweg","sequence":"first","affiliation":[{"name":"From the H\u00f4pitaux Universitaires de Geneve, Geneva; Swiss Group for Clinical Cancer Research, Bern; Basel University Hospital, Basel, Switzerland; Medizinische Klinik II, St Johannes Hospital, Duisburg; Hannover Medical School, Hannover; University Hospital Mannheim, Mannheim; Friedrich-Schiller-Universit\u00e4t Jena, Jena, Germany; and Vrije Universiteit University Medical Center, Amsterdam, the Netherlands."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aristoteles A.N.","family":"Giagounidis","sequence":"additional","affiliation":[{"name":"From the H\u00f4pitaux Universitaires de Geneve, Geneva; Swiss Group for Clinical Cancer Research, Bern; Basel University Hospital, Basel, Switzerland; Medizinische Klinik II, St Johannes Hospital, Duisburg; Hannover Medical School, Hannover; University Hospital Mannheim, Mannheim; Friedrich-Schiller-Universit\u00e4t Jena, Jena, Germany; and Vrije Universiteit University Medical Center, Amsterdam, the Netherlands."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mathew","family":"Simcock","sequence":"additional","affiliation":[{"name":"From the H\u00f4pitaux Universitaires de Geneve, Geneva; Swiss Group for Clinical Cancer Research, Bern; Basel University Hospital, Basel, Switzerland; Medizinische Klinik II, St Johannes Hospital, Duisburg; Hannover Medical School, Hannover; University Hospital Mannheim, Mannheim; Friedrich-Schiller-Universit\u00e4t Jena, Jena, Germany; and Vrije Universiteit University Medical Center, Amsterdam, the Netherlands."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carlo","family":"Aul","sequence":"additional","affiliation":[{"name":"From the H\u00f4pitaux Universitaires de Geneve, Geneva; Swiss Group for Clinical Cancer Research, Bern; Basel University Hospital, Basel, Switzerland; Medizinische Klinik II, St Johannes Hospital, Duisburg; Hannover Medical School, Hannover; University Hospital Mannheim, Mannheim; Friedrich-Schiller-Universit\u00e4t Jena, Jena, Germany; and Vrije Universiteit University Medical Center, Amsterdam, the Netherlands."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christiane","family":"Dobbelstein","sequence":"additional","affiliation":[{"name":"From the H\u00f4pitaux Universitaires de Geneve, Geneva; 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Swiss Group for Clinical Cancer Research, Bern; Basel University Hospital, Basel, Switzerland; Medizinische Klinik II, St Johannes Hospital, Duisburg; Hannover Medical School, Hannover; University Hospital Mannheim, Mannheim; Friedrich-Schiller-Universit\u00e4t Jena, Jena, Germany; and Vrije Universiteit University Medical Center, Amsterdam, the Netherlands."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wolf-Karsten","family":"Hofmann","sequence":"additional","affiliation":[{"name":"From the H\u00f4pitaux Universitaires de Geneve, Geneva; Swiss Group for Clinical Cancer Research, Bern; Basel University Hospital, Basel, Switzerland; Medizinische Klinik II, St Johannes Hospital, Duisburg; Hannover Medical School, Hannover; University Hospital Mannheim, Mannheim; Friedrich-Schiller-Universit\u00e4t Jena, Jena, Germany; and Vrije Universiteit University Medical Center, Amsterdam, the Netherlands."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kristina","family":"Schilling","sequence":"additional","affiliation":[{"name":"From the H\u00f4pitaux Universitaires de Geneve, Geneva; 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