Vitamin D(2) analog (Paricalcitol; Zemplar) for treatment of myelodysplastic syndrome.

Abstract

Myelodysplastic syndrome (MDS) is often a pernicious disorder associated with pancytopenia in the elderly; therapeutic approaches need to balance their toxicities versus the symptoms of the disease. 1,25(OH)(2)-Vitamin-D(3) [1,25(OH)(2)D(3)] inhibits proliferation and induces differentiation of leukemic cells in vitro. Small clinical trials of 1,25(OH)(2)D(3) have shown modest efficacy in MDS; hypercalcemia prevented the administration of doses that have been shown to be effective in vitro. Paricalcitol [19-nor-1,25(OH)(2)D(2), Zemplar] has been approved by the FDA for treatment of secondary hyperparathyroidism. This Vitamin D analog is unique because it has little hypercalcemic potential; but in vitro, it has strong anti-leukemic activity. We conducted a clinical trial of oral paricalcitol to 12 MDS patients whose disease varied between an IPSS of low to high. Drug was well-tolerated in all patients. No responses were observed according to international working group (IWG) criteria. However, the platelet count of 1 of the 12 individuals rose from 53,500 to 120,000/microl blood over 5 weeks; but the patient succumbed to a fatal fungal infection. In summary, paricalcitol given as a single agent to MDS patients is therapeutically not very efficacious; further trials of the Vitamin D analog should be considered in combination with other approaches.

• Authors: H Phillip Koeffler, Noune Aslanian, James O'Kelly
• Journal: Leukemia research (Leuk Res) Vol. 29 Issue 11 Pg. 1259-62 (Nov 2005) ISSN: 0145-2126 [Print] England
• PMID: 16164982 (Publication Type: Clinical Trial, Journal Article, Research Support, N.I.H., Extramural, Research Support, Non-U.S. Gov't, Research Support, U.S. Gov't, P.H.S.)

Chemical References

• Ergocalciferols
• paricalcitol

Topics

• Administration, Oral
• Aged
• Aged, 80 and over
• Dose-Response Relationship, Drug
• Drug Administration Schedule
• Ergocalciferols (administration & dosage, therapeutic use)
• Female
• Humans
• Male
• Middle Aged
• Myelodysplastic Syndromes (diagnosis, drug therapy)
• Treatment Outcome