Glucocorticoid therapy in the preleukemic syndrome (hemopoietic dysplasia). Identification of responsive patients using in-vitro techniques

Bone marrow cells from 54 patients with the preleukemic syndrome were cultured in agar (granulocyte colony forming units) in the presence and absence of cortisol. Thirty-four patients were given trials of prednisone therapy after the initial culture was performed. Cortisol (in vitro) failed to enhance colony growth in 29 of these 34 cases, and none of the 29 patients responded to prednisone therapy. Cortisol enhanced colony growth in five patients and three of these responded favorably to prednisone therapy. The correlation of in-vivo with in-vitro events is significant (P<0.005). Glucocorticoid therapy is of value in the management of a small number of patients with the preleukemic syndrome but is hazardous in those who fail to respond. These preliminary observations suggest that bone marrow cell culture techniques may aid in the identification of those patients who will and those who will not respond favorably to such therapy.