Megadose Methylprednisolone for Myelofibrosis

Şinasi Özsoylu, MD, Professor of Paediatrics and Haematology, Hacettepe University Faculty of Medicine, Department of Paediatrics, Haematology Unit and Hacettepe Children’s Hospital, Ankara 06100 (Turkey) A case of myelofibrosis in association with systemic lupus erythemato-sus was recently presented by Inoue et al. in this Journal [1]. Myelofibrosis was corrected by using high-dose methylprednisolone (1,000 mg/day). On this occasion, I would like to remind that high-dose methylprednisolone (30 mg/kg/day for 3 days, 20 mg/ kg/day for 4 days) and, subsequently, 10, 5, 2 and 1 mg/kg for 1 week each; each dose given within 2-10 min before 9 a.m. was used successfully by us for the first time in the treatment of myelofibrosis in children as well as adults [2-5]. I would like to add that 3 of 4 children are alive and well 6, 3 and 2 years after discontinuation of the treatment. One died from non-haematologic causes. One of the adult patients died from myocardial infarction but a 35-year-old woman has been free of disease for more than 3 years. Since 5-10 mg/kg methylprednisolone has been called a high dose, we prefer to use the term ‘megadose’ for the dose suggested by us [6]. References Inoue Y, Matsubara A, Okuya S, Akafuji K, Kaku K, Kaneko T: Myelofibrosis and systemic lupus erythematosus: Reversal of fibrosis with high-dose corticosteroid therapy. Acta Haematol 1992;88:32-36. Özsoylu §, Ruacan S: High dose intravenous corticosteroid treatment in childhood idio-pathic myelofibrosis. Acta Haematol 1986;75: 49-51. Özsoylu §: High-dose intravenous methylprednisolone for idiopathic myelofibrosis. Lancet 1988;i:766. Özsolylu §: High dose intravenous methylprednisolone for idiopathic myelofibrosis. Br J Haematol 1988;70:388. Özsoylu §, Ruacan §, Karaaslan Y, Dündar S: Mega dose intravenous methylprednisolone in adult idiopathic myelofibrosis. Hematol Rev 1991;5:121-128. Suarez CR, Rademaker D, Hasson A, Mon-gogna L: High-dose steroid in childhood acute idiopathic thrombocytopenic purpura. Am J Pediatr Hematol Oncol 1986;8:111-115.