Myelodysplasia and bone marrow fibrosis treated with calcitriol and venesection

We report a patient with myelodysplasia and bone marrow fibrosis. We managed him with regular blood transfusion for a period of 16 months. A modest dose of calcitriol (1,25-dihydroxycholecalciferol) 0.75 microg daily for 12 weeks resulted in a gradual but complete response in his haemoglobin level. There were significant bone marrow changes in that the fibrosis has completely disappeared although the marrow cytology remained dysplastic. The normal haemoglobin level persists despite an intensive venesection programme aimed at reducing iron overload. We conclude that calcitriol should be given for at least 12 weeks in patients with myelodysplasia especially if there is a fibrotic element in the bone marrow. The role of venesection in maintaining remission is a speculative.