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Effect of Oxymetholone in Refractory Anemia

Effect of Oxymetholone in Refractory Anemia Abstract Until recently, the prognosis of refractory anemia could be summarized in the following terms: "Marrow aplasia cannot be reversed by any known means. Supportive therapy with transfusions and antibiotics is usually necessary and, in milder cases, may prolong life until spontaneous recovery of marrow function occurs." 29 With the exception of the rare cases in which splenectomy improved the clinical and hematological picture, the course of the disease was but slightly modified by therapy.17,21,26 The present outlook is brighter since androgenic hormone therapy has been introduced in this condition.31 The testosterone derivatives used (methyltestosterone; testosterone cyclopentylate, enanthate, and propionate; and fluoxymesterone) have several disadvantages consisting of bone-maturating and virilizing actions; some of the derivatives are orally inactive or produce liver damage. In view of this, it seemed advisable to investigate, in patients with medular insufficiency, the therapeutic action of oxymetholone (2-hydroxymethylene-17α-methyldihydrotestosterone), an anabolic hormone with less virilizing activity. References 1. Kindly supplied by Laboratories Syntex, SA, Mexico, as Anasteron. 2. A 6-year-old patient with congenital hypoplastic anemia (Blackfan-Diamond syndrome), not included in this study, showed no radiological evidence of bone alteration after two years of continuous treatment with 1-2 mg/kg/day of oxymetholone. 3. References 2, 4, 9, 13, 15, 18, 19, 22-25, and 30-32. 4. Burke, H. A., and Liddle, G. W.: Studies of Structure Function Relationship of Steroids: Anabolic Potency of Some Testosterone Analogues , Helv Med Acta 27:504,1960. 5. Clement, D. H.: Aplastic Anemia , Pediat Clin N Amer 9:703, 1962. 6. Cline, M. J., and Berlin, N. I.: Studies of the Anemia of Multiple Myeloma , Amer J Med 33:510, 1962.Crossref 7. Coletta, A.; Esposito, L.; and Palomby, L.: Su alcuni recenti orientamenti terapeutici in tema di pancitopenia ipoplastica: Testosterone e steroidi anabolici , Pediatria 59:413, 1961. 8. Crosby, W. H.: Panels in Therapy: XII. Hypoplastic-Aplastic Anemia , Blood 12:193, 1957. 9. Denko, C. W., and Schroeder, L. R.: Ecchymotic Skin Lesions in Patients Receiving Prednisone , JAMA 164:41, 1957.Crossref 10. Diamond, L. K.: Personal communication to the authors. 11. Fossi, G. L., and Simpson, S. L.: Oral Methyl-Testosterone and Jaundice , Brit Med J 1:259, 1959.Crossref 12. Domínguez, J. L.: " Anemia refractaria tratada con esteroides y anabólicos ," in Memorias de la II Jornada Anual de la Agrupación Mexicana para el Estudio de la Hematología , México, 1961, p 21. 13. Dorfman, R. I.; Kincl, F. A.; and Ringold, H. J.: Anti-Estrogen Assay of Neutral Steroids Administered by Subcutaneous Injection , Endocrinology 68:17, 1961.Crossref 14. Dorfman, R. I.; Kincl, F. A.; and Ringold, H. J.: Anti-Estrogen Assay of Neutral Steroids Administered by Gavage , Endocrinology 68:43, 1961.Crossref 15. Dreyfus, B.: A propos de 81 observations de pancytopénies idiopathiques chroniques sans spélnomégalie , Rev Hemat 14:62, 1959. 16. Gardner, F. H., and Pringle, J. C., Jr.: Androgens and Erythropoiesis , Arch Intern Med 107:846, 1961.Crossref 17. Gardner, F. H., and Nathan, D. G.: Hypochromic Anemia and Hemochromatosis: Response to Combined Testosterone, Pyridoxine and Liver Extract Therapy , Amer J Med Sci 243:447, 1962.Crossref 18. Gardner, F. H.: " Non-Nutritional Agents Associated With Non-Specific Stimulation of Erythropoiesis in Man ," in Jacobson, L. O., and Doyle, M.: Erythropoiesis , New York: Grune & Stratton, Inc., 1962, p 263. 19. Heaney, R. P., and Whedom, G. D.: Impairment of Hepatic Bromsulphalein Clearance by Two 17-Substituted Tetesterone , J Lab Clin Med 52:169, 1958. 20. Heaton, L. D.; Crosby, W. H.; and Cohen, H.: Splenectomy in the Treatment of Hypoplasia of the Bone Marrow , Ann Surg 146:637, 1957.Crossref 21. Huguley, C. M., Jr.: Aplastic Anemia Treated With Prednisone, Thyroid, Testosterone and Growth Hormone, Abstract , Blood 15:426, 1960. 22. Khalil, M., and Ibrahim, A. H.: The Treatment of Aplastic Anemia With Anabolic Steroids , Acta Paediat 51:501, 1962.Crossref 23. Israels, M. C. G., and Wilkinson, J. F.: Idiopathic Aplastic Anemia , Lancet 1:63, 1961.Crossref 24. Jamra, M.; Vasconcellos, E.; Mauro, E.; and Gillo, D. M.: Mielose aplastica: Estudio de 25 casos , Rev Ass Med Brasil 1:35, 1954. 25. Jeune, M.; Germain, D.; Humbert, G.; and Nivelon, J. L.: Androgénothérapie et corticothérapie associées dans l'anemie de Fanconi , Pediatrie 15: 687, 1960. 26. Kennedy, B. J., and Gilbertsen, A. S.: Increased Erythropoiesis Induced by Androgenic-Hormone Therapy , New Eng J Med 256:719, 1957.Crossref 27. Kennedy, B. J.: Stimulation of Erythropoiesis by Androgenic Hormones , Ann Intern Med 57:917, 1962.Crossref 28. Lehnoff, H. J.: Androgen Therapy for Refractory Anemia: Report of a Case Associated With Thymoma , Ann Intern Med 53:1059, 1960.Crossref 29. Mohler, D. N., and Leavell, B. S.: Aplastic Anemia: An Analysis of 50 Cases , Ann Intern Med 49:326, 1958.Crossref 30. Romero, F.: Personal communication to the authors. 31. Sánchez-Medal, L.: Unpublished data. 32. Scott, J. L.; Cartwright, G. E.; and Wintrobe, M. M.: Acquired Aplastic Anemia: An Analysis of 39 Cases and Review of the Pertinent Literature , Medicine (Balt) 38:119, 1959. 33. Seip, M.: Aplastic Anemia Treated With Anabolic Steroids and Corticosteroids , Acta Pediat 50:561, 1961.Crossref 34. Shahadi, N. T., and Diamond, L. K.: Testosterone-Induced Remission in Aplastic Anemia , AMA J Dis Child 98:293, 1959. 35. Shahidi, N. T., and Diamond, L. K.: Testosterone-Induced Remission in Aplastic Anemia of Both Acquired and Congenital Types: Further Observations in 24 Cases , New Eng J Med 264:953, 1961.Crossref 36. Wernze, H., and Kruschke, H. J.: Androgenic Steroids and Liver Function , Brit Med J 1:1956, 1960.Crossref 37. Bomford, R. R., and Rhoads, C. P.: Refractory Anaemia: I. Clinical and Pathological Changes , Quart J Med 10:175, 1941. 38. Wintrobe, M. M.: Clinical Hematology , Philadelphia: Lea & Febiger, Publishers, 1961, p 551. http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Archives of Internal Medicine American Medical Association

Effect of Oxymetholone in Refractory Anemia

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Publisher
American Medical Association
Copyright
Copyright © 1964 American Medical Association. All Rights Reserved.
ISSN
0003-9926
eISSN
1538-3679
DOI
10.1001/archinte.1964.00280110101020
Publisher site
See Article on Publisher Site

Abstract

Abstract Until recently, the prognosis of refractory anemia could be summarized in the following terms: "Marrow aplasia cannot be reversed by any known means. Supportive therapy with transfusions and antibiotics is usually necessary and, in milder cases, may prolong life until spontaneous recovery of marrow function occurs." 29 With the exception of the rare cases in which splenectomy improved the clinical and hematological picture, the course of the disease was but slightly modified by therapy.17,21,26 The present outlook is brighter since androgenic hormone therapy has been introduced in this condition.31 The testosterone derivatives used (methyltestosterone; testosterone cyclopentylate, enanthate, and propionate; and fluoxymesterone) have several disadvantages consisting of bone-maturating and virilizing actions; some of the derivatives are orally inactive or produce liver damage. In view of this, it seemed advisable to investigate, in patients with medular insufficiency, the therapeutic action of oxymetholone (2-hydroxymethylene-17α-methyldihydrotestosterone), an anabolic hormone with less virilizing activity. References 1. Kindly supplied by Laboratories Syntex, SA, Mexico, as Anasteron. 2. A 6-year-old patient with congenital hypoplastic anemia (Blackfan-Diamond syndrome), not included in this study, showed no radiological evidence of bone alteration after two years of continuous treatment with 1-2 mg/kg/day of oxymetholone. 3. References 2, 4, 9, 13, 15, 18, 19, 22-25, and 30-32. 4. Burke, H. A., and Liddle, G. W.: Studies of Structure Function Relationship of Steroids: Anabolic Potency of Some Testosterone Analogues , Helv Med Acta 27:504,1960. 5. Clement, D. H.: Aplastic Anemia , Pediat Clin N Amer 9:703, 1962. 6. Cline, M. J., and Berlin, N. I.: Studies of the Anemia of Multiple Myeloma , Amer J Med 33:510, 1962.Crossref 7. Coletta, A.; Esposito, L.; and Palomby, L.: Su alcuni recenti orientamenti terapeutici in tema di pancitopenia ipoplastica: Testosterone e steroidi anabolici , Pediatria 59:413, 1961. 8. Crosby, W. H.: Panels in Therapy: XII. Hypoplastic-Aplastic Anemia , Blood 12:193, 1957. 9. Denko, C. W., and Schroeder, L. R.: Ecchymotic Skin Lesions in Patients Receiving Prednisone , JAMA 164:41, 1957.Crossref 10. Diamond, L. K.: Personal communication to the authors. 11. Fossi, G. L., and Simpson, S. L.: Oral Methyl-Testosterone and Jaundice , Brit Med J 1:259, 1959.Crossref 12. Domínguez, J. L.: " Anemia refractaria tratada con esteroides y anabólicos ," in Memorias de la II Jornada Anual de la Agrupación Mexicana para el Estudio de la Hematología , México, 1961, p 21. 13. Dorfman, R. I.; Kincl, F. A.; and Ringold, H. J.: Anti-Estrogen Assay of Neutral Steroids Administered by Subcutaneous Injection , Endocrinology 68:17, 1961.Crossref 14. Dorfman, R. I.; Kincl, F. A.; and Ringold, H. J.: Anti-Estrogen Assay of Neutral Steroids Administered by Gavage , Endocrinology 68:43, 1961.Crossref 15. Dreyfus, B.: A propos de 81 observations de pancytopénies idiopathiques chroniques sans spélnomégalie , Rev Hemat 14:62, 1959. 16. Gardner, F. H., and Pringle, J. C., Jr.: Androgens and Erythropoiesis , Arch Intern Med 107:846, 1961.Crossref 17. Gardner, F. H., and Nathan, D. G.: Hypochromic Anemia and Hemochromatosis: Response to Combined Testosterone, Pyridoxine and Liver Extract Therapy , Amer J Med Sci 243:447, 1962.Crossref 18. Gardner, F. H.: " Non-Nutritional Agents Associated With Non-Specific Stimulation of Erythropoiesis in Man ," in Jacobson, L. O., and Doyle, M.: Erythropoiesis , New York: Grune & Stratton, Inc., 1962, p 263. 19. Heaney, R. P., and Whedom, G. D.: Impairment of Hepatic Bromsulphalein Clearance by Two 17-Substituted Tetesterone , J Lab Clin Med 52:169, 1958. 20. Heaton, L. D.; Crosby, W. H.; and Cohen, H.: Splenectomy in the Treatment of Hypoplasia of the Bone Marrow , Ann Surg 146:637, 1957.Crossref 21. Huguley, C. M., Jr.: Aplastic Anemia Treated With Prednisone, Thyroid, Testosterone and Growth Hormone, Abstract , Blood 15:426, 1960. 22. Khalil, M., and Ibrahim, A. H.: The Treatment of Aplastic Anemia With Anabolic Steroids , Acta Paediat 51:501, 1962.Crossref 23. Israels, M. C. G., and Wilkinson, J. F.: Idiopathic Aplastic Anemia , Lancet 1:63, 1961.Crossref 24. Jamra, M.; Vasconcellos, E.; Mauro, E.; and Gillo, D. M.: Mielose aplastica: Estudio de 25 casos , Rev Ass Med Brasil 1:35, 1954. 25. Jeune, M.; Germain, D.; Humbert, G.; and Nivelon, J. L.: Androgénothérapie et corticothérapie associées dans l'anemie de Fanconi , Pediatrie 15: 687, 1960. 26. Kennedy, B. J., and Gilbertsen, A. S.: Increased Erythropoiesis Induced by Androgenic-Hormone Therapy , New Eng J Med 256:719, 1957.Crossref 27. Kennedy, B. J.: Stimulation of Erythropoiesis by Androgenic Hormones , Ann Intern Med 57:917, 1962.Crossref 28. Lehnoff, H. J.: Androgen Therapy for Refractory Anemia: Report of a Case Associated With Thymoma , Ann Intern Med 53:1059, 1960.Crossref 29. Mohler, D. N., and Leavell, B. S.: Aplastic Anemia: An Analysis of 50 Cases , Ann Intern Med 49:326, 1958.Crossref 30. Romero, F.: Personal communication to the authors. 31. Sánchez-Medal, L.: Unpublished data. 32. Scott, J. L.; Cartwright, G. E.; and Wintrobe, M. M.: Acquired Aplastic Anemia: An Analysis of 39 Cases and Review of the Pertinent Literature , Medicine (Balt) 38:119, 1959. 33. Seip, M.: Aplastic Anemia Treated With Anabolic Steroids and Corticosteroids , Acta Pediat 50:561, 1961.Crossref 34. Shahadi, N. T., and Diamond, L. K.: Testosterone-Induced Remission in Aplastic Anemia , AMA J Dis Child 98:293, 1959. 35. Shahidi, N. T., and Diamond, L. K.: Testosterone-Induced Remission in Aplastic Anemia of Both Acquired and Congenital Types: Further Observations in 24 Cases , New Eng J Med 264:953, 1961.Crossref 36. Wernze, H., and Kruschke, H. J.: Androgenic Steroids and Liver Function , Brit Med J 1:1956, 1960.Crossref 37. Bomford, R. R., and Rhoads, C. P.: Refractory Anaemia: I. Clinical and Pathological Changes , Quart J Med 10:175, 1941. 38. Wintrobe, M. M.: Clinical Hematology , Philadelphia: Lea & Febiger, Publishers, 1961, p 551.

Journal

Archives of Internal MedicineAmerican Medical Association

Published: May 1, 1964

References