Bone marrow failure

• Abundant pre-clinical data give biological plausibility to a suppressive effect of IOL on hematopoiesis, which may involve hematopoietic stem cells, cytokines, and the bone marrow microenvironment^1-5.
• ICT and/or antioxidants can reverse or attenuate this effect⁶.
• In clinical studies of ICT in MDS, a significant minority of patients had HI, including achievement of semi-durable RBC transfusion independence.
• It will be important in future to identify clinical factors predictive of HI in patients receiving ICT^7,8.
• For a detailed discussion of potential mechanisms of hematologic suppression with IOL, see Leitch & Gattermann (2019)⁹.