Blood biomarkers and medication response following group psychotherapy as an add-on treatment in refractory idiopathic myelodysplasia

Background: Refractory anemia is a hallmark of myelodysplastic syndromes (MDSs), a heterogeneous group of clonal hematopoietic stem cell disorders. Approximately 12% of MDS patients are under 50 years old, and nearly 50% exhibit poor response to standard treatments. Psychodynamic psychotherapy has been shown to be particularly effective in treating somatic disorders and medically unexplained symptoms. Objective: This study reports a clinical case in which group psychotherapy, in combination with standard treatment, led to improvements in hematological parameters and treatment response in a patient with MDS. Methods: A 48-year-old male patient diagnosed with idiopathic refractory myelodysplasia was undergoing treatment with epoetin (40,000 IU/ml, twice weekly) and vitamin B12 (1 g/day). The patient, experiencing depressive and obsessive symptoms, voluntarily initiated a group psychotherapy, based on the Human Birth Theory, a framework that fosters a clinician's focus on curability and vitality. Results: The patient experienced gradual improvements in both psychological and medical conditions. Hematological para-meters began to improve after two years of therapy, reaching a stable normal range after four years. Psychological assessments (Beck Depression Inventory and Beck Anxiety Inventory) showed significant improvement post-treatment. After six years and five months, the patient completed psychotherapy. Four months later, pharmacological treatment was discontinued, with sustained clinical stability. Conclusion: This case suggests that clinicians' attitude and an idea of curability can be crucial for the patient's psychological response to the treatment. Given the potential negative impact of psychiatric comorbidities on treatment efficacy and disease progression, psychological interventions can be considered as part of an integrated therapeutic approach. Psychotherapy based on the Human Birth Theory may offer specific benefits by fostering a more vital psychological response in the patient, in line with its foundational principles.