Treatment of the bone marrow failure in Fanconi anemia patients with danazol

Kathrin Scheckenbach, Mary Morgan, Judith Filger-Brillinger, Matthias Sandmann, Bruce Strimling, Wolfram Scheurlen, Detlev Schindler, U. Göbel, Helmut Hanenberg
In: Blood Cells, Molecules, and Diseases · 2011 · vol. 48(2) , pp. 128–131 · doi:10.1016/j.bcmd.2011.11.006 · PMID:22178060 · W2050898703
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This retrospective study of eight Fanconi anemia patients found that danazol effectively and safely increased hemoglobin and platelet counts, maintaining stability for up to three years without severe side effects.

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Abstract

More than 90% of Fanconi anemia (FA) patients experience progressive bone marrow failure during life with a median onset at 8 years of age. As matched sibling donor transplantation as preferred treatment is not available for the majority of patients, several synthetic androgens have been used as short-term treatment options for the marrow failure in FA patients for more than 50 years. Here, we retrospectively collected data on eight FA patients who received danazol for the off-label treatment of their marrow failure at a starting dose of approximately 5mg/kg body weight/die. The hematological parameters at the initiation of treatment were hemoglobin (Hb) <8 g/dL and/or thrombocytes 50% over the starting counts within 6 months and remained stable for up to 3 years despite careful reduction of the danazol dose per kg body weight. In 4 patients with a follow-up of 3 years, the platelets finally reached an average of 68,000/μL or 2.8 times over the starting values, while the Hb remained stable >11 g/dL. Danazol was reduced to 54% of the starting dose or 2.6 mg/kg/die. One FA-A patient with an unusually severe phenotype did not response with her PB counts to either danazol or oxymethalone within 6 months. None of the patients developed severe or unacceptable side-effects from the danazol treatment that led to the discontinuation of therapy. This initial description suggests that danazol might be an effective and well-tolerated treatment option for delaying the progressive marrow failure in FA patients for at least 3 years and longer.

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