New Biological Insights and Recent Therapeutic Advances in the Management of Acute and Chronic Leukemias and Myelodysplastic SyndromesLenalidomide for patients with transfusion-dependent, low-risk MDS without del(5q)
2:10 minutes.
TRANSCRIPTION:
DR STOCK: This was actually a nice study, and it confirmed a smaller, earlier study that I think many of us were skeptical that lenalidomide might be at all effective in patients who were transfusion dependent lower-risk MDS outside of the patients with a 5q-minus syndrome. And there was an earlier trial performed by Dr Razaand colleagues that showed about a 20% to 25% response rate, transfusion independence, that was quite durable in an earlier study. And that’s exactly what was shown here in this particular study, which was nice to see the confirmatory data and gives one some hope that the lower-risk MDS patients who fail to respond anymore to erythrocyte-stimulating agents may respond to lenalidomide. DR LOVE: So David, is that a strategy that you’re using in your practice? DR STEENSMA: We do tend to use that for patients, especially if their platelets are reasonable, because platelets are a big predictor of response. Somebody severely thrombocytopenic, they’re not going to respond to lenalidomide. So somebody who has a normal karyotype, trisomy 8, one of these lower-risk karyotypes, nondel-5q, that’s a reasonable patient to use it on. Somebody who has a complex karyotype with monosomy 7, not likely to respond. DR LOVE: So Doug, how do you approach the use of lenalidomide in MDS? And what, specifically in terms of dosing? How do you approach it? DR SMITH: It’s erythroid stimulating. So patients that their anemia is their biggest problem, patients with lower-risk disease and patients — I agree with David that patients without other cytopenias in the mix, I’m willing to give people a trial of lenalidomide. I have started lower. I start at 5 mg a day, most commonly, particularly my older patients. There are some folks we maintain on 5 mg every other day or even twice a week in a maintenance strategy. But I do start lower, because I’m afraid of other cytopenias. And if anemia is what I’m trying to fix in these folks, I am wiling to give lenalidomide a try. |