Severe, often refractory anemia is characteristic of the myelodysplastic syndrome associated with chromosome 5q31 deletion. We investigated whether lenalidomide (CC5013) could reduce the transfusion requirement and suppress the abnormal 5q31– clone in patients with this disorder.

Methods One hundred forty-eight patients received 10 mg of lenalidomide for 21 days every 4 weeks or daily. Hematologic, bone marrow, and cytogenetic changes were assessed after 24 weeks of treatment by an intention-to-treat analysis.

Results Among the 148 patients, 112 had a reduced need for transfusions (76%; 95% confidence interval [CI], 68 to 82) and 99 patients (67%; 95% CI, 59 to 74) no longer required transfusions, regardless of the karyotype complexity. The response to lenalidomide was rapid (median time to response, 4.6 weeks; range, 1 to 49) and sustained; the median duration of transfusion independence had not been reached after a median of 104 weeks of follow-up. The maximum hemoglobin concentration reached a median of 13.4 g per deciliter (range, 9.2 to 18.6), with a corresponding median rise of 5.4 g per deciliter (range, 1.1 to 11.4), as compared with the baseline nadir value before transfusion. Among 85 patients who could be evaluated, 62 had cytogenetic improvement, and 38 of the 62 had a complete cytogenetic remission. There was complete resolution of cytologic abnormalities in 38 of 106 patients whose serial bone marrow samples could be evaluated. Moderate-to-severe neutropenia (in 55% of patients) and thrombocytopenia (in 44%) were the most common reasons for interrupting treatment or adjusting the dose of lenalidomide.

Conclusions Lenalidomide can reduce transfusion requirements and reverse cytologic and cytogenetic abnormalities in patients who have the myelodysplastic syndrome with the 5q31 deletion. (ClinicalTrials.gov number, NCT00065156 [ClinicalTrials.gov] .)

Source Information

From the University of South Florida College of Medicine and H. Lee Moffitt Cancer Center and Research Institute, Tampa (A.L.); Mayo Clinic, Rochester, MN (G.D.); University of Rochester, Rochester, NY (J.B.); St. Johannes Hospital, Duisberg, Germany (A.G.); University of Massachusetts, Worcester (A.R.); Cornell Medical Center, New York (E.F.); Wake Forest University, Winston-Salem, NC (B.P.); Stanford University, Stanford, CA (P.G.); M.D. Anderson Cancer Center, Houston (D.T.); Dana–Farber Cancer Institute, Boston (R.S.); Mayo Clinic, Scottsdale, AZ (C.R.); and Celgene Corporation, Warren, NJ (K.W., J.P., M.S., J.Z., R.K.).

Address reprint requests to Dr. List at the Malignant Hematology Division, SRB-4, H. Lee Moffitt Cancer Center and Research Institute, 12902 Magnolia Dr., Tampa, FL 33612-9497, or at heberten@moffitt.usf.edu .

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