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We report three cases of myelodysplastic syndrome (MDS), refractory anemia with ringed sideroblasts (RARS), who responded to the anti-malarial chloroquine in combination with recombinant erythropoietin (darbepoetin alfa). All three patients either remained or achieved transfusion independence and increased their hemoglobin level by at least 1 gm/dl. Responses occurred rapidly, becoming clinically noticeable within the first 4-6 weeks from start of therapy. All patients were followed for at least a 6 months period during which they have remained transfusion independent. Chloroquine affects multiple cellular pathways, but the precise mechanism of its action in RARS patients is unclear..read more
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