The different mechanisms of action between Antithymocyte globulin and cyclosporine can improve the effectivity when both are used in combination in patients with myelodysplastic syndrome.

Patients are treated with:

Antithymocyte globulin (Timoglobulin SangStat)

• 2,5 mg/kg/day IV over 8 hours on days 1-4
• Total dose: 10 mg/kg
• Calculated dose adjusted to ideal weight
• Especial considerations:

Paracetamol 1 gr (oral or IV) Dexclorfeniramine 5 mg IV Methylprednisolone 1 mg/kg IV 30 minutes before Timoglobulin and repeat if necessary at 4 hours - Platelet transfusion if platelet count is < 50 x 109/L

Cyclosporine (Sandimmun Neoral)

-2,5 mg/kg/12 h over 3 months

Inclusion Criteria:

• Diagnosis of low or intermediate risk myelodysplastic syndrome (MDS) (or high risk patient not eligible to intensive chemotherapy or for bone marrow transplantation), excluding chronic myelomonocytic leukemia
• At less one of two following conditions:
• Transfusion dependence: 1)Packed red blood cell transfusions greater than 2 times; 2)Untransfused hemoglobin level no greater than 10 g/dL; 3)Platelet transfusions greater than 1 time
• Infection grade III or IV secondary to neutropenia
• ECOG < or = 2

Exclusion Criteria:

• Chronic myelomonocytic leukemia
• Creatinine greater than 2 mg/dl
• Bilirubin greater than 2.5 mg/dl
• History of heart failure
• History of allergy to rabbit proteins