Lenalidomide decreases transfusion dependence in MDS not related to 5q deletion

Issue: February 10, 2008

Lenalidomide is active in transfusion-dependent patients with anemia related to low- or intermediate-1–risk myelodysplastic syndromes that are not associated with the chromosome 5q deletion, according to recent data.

Researchers of a large multicenter phase-2 study evaluated the efficacy of lenalidomide (Revlimid, Celgene) in this setting. Lenalidomide is currently indicated for the treatment of anemia resulting from myelodysplastic syndromes that are associated with the chromosome 5q deletion.

The study included 214 patients who received 10 mg lenalidomide daily or on days one to 21 of a 28-day cycle. Fifty-six patients became red blood cell transfusion-independent after a median treatment of 4.8 weeks. The median duration of transfusion independence was 41 weeks. Thirty-seven patients had a 50% or greater reduction in transfusion requirements. – by Emily Shafer

Blood. 2008;111:86-93.

In previous studies, lenalidomide resulted in dramatic clinical and cytogenetic responses in patients with the 5q deletion cytogenetic abnormality. The current data also showed a benefit, although not as striking, in patients without this abnormality. The responses were almost exclusively in the erythroid lineage. Responses to lenalidomide tended to occur quicker and the oral administration is simpler than with existing parenteral drugs. The response rate to hypomethylating agents is currently less well-defined in this lower risk group of patients, although tri-lineage responses have been reported. There is a study planned to determine whether adding erythropoietin to lenalidomide is more effective than lenalidomide alone. The mechanism by which patients respond to lenalidomide is unknown, and a genomic study to detect possible similarities between responding patients with or without 5q deletion would be of interest.

– Charles A. Schiffer, MD

HemOnc Today Editorial Board Member