Treatment-Recalcitrant Lower-risk Myelodysplastic Syndrome Successfully Treated with Long-term Azacitidine in an Elderly Male

Abstract

Low levels of white blood cells (WBC) were identified in a 60-year-old male, and he was diagnosed as having myelodysplastic syndrome (MDS) refractory anemia with excess blasts-1 (RAEB-1). On the International Prognostic Scoring System he was scored at Intermediate-1 (IPSS Int-1). He was treated with anabolic steroids, immunosuppressants, and vitamin D·K, but the platelet count decreased. At 66 years of age, the platelet count had decreased to 32,000 (/μL), and the patient was diagnosed as having refractory cytopenia with multilineage dysplasia (RCMD), IPSS Int-1. We considered that observation and blood transfusion would not improve his prognosis, so azacitidine was administered following which recovery of the platelet levels and improvement of the bone marrow were subsequently observed. He has been treated with azacitidine for 45 courses, and the same treatment is currently maintained with the patient, now 70 years of age, in good condition. Our results suggest that we should examine the effect of azacitidine in lower-risk-MDS which have been treated unsuccessfully with conventional therapy.