Lenalidomide has emerged as an effective therapeutic alternative for the management of anemia in lower-risk myelodysplastic syndromes (MDS). Compelling results from phase I and phase II clinical studies prompted the US Food and Drug Administration to approve lenalidomide for the treatment of transfusion-dependent MDS patients with interstitial deletion of chromosome 5q [del(5q)]. Subsequently, the National Comprehensive Cancer Network (NCCN) has incorporated lenalidomide into their current treatment algorithm for the treatment of lower-risk del(5q) patients. This discussion examines the current NCCN guidelines for the treatment of these patients, including the management of anemia in lower-risk MDS, and discusses the potential future therapeutic applications of lenalidomide in this disease.
References
1.
OlivaE.N., DimitrovB.D., BenedettoF.Hemoglobin level threshold for cardiac remodeling and quality of life in myelodysplastic syndromes. Leuk Res.2005; 29: 1217–1219.
2.
MalcovatiL., PortaM.G., PascuttoC.Prognostic factors and life expectancy in myelodysplastic syndromes classified according to WHO criteria: a basis for clinical decision making. J Clin Oncol.2005; 23: 7594–7603.
3.
GreenbergP., CoxC., LeBeauM.M.International scoring system for evaluating prognosis in myelodysplastic syndromes. Blood.1997; 89: 2079–2088.
4.
GoreS.Classification, treatment goals, and management principles for myelodysplastic syndromes. Cancer Control.2004; 11(suppl): 3–6.
National Comprehensive Cancer Network (NCCN)Clinical Practice Guidelines in Oncology v4.2006. Myelodysplastic syndromes.2006 National Comprehensive Cancer Network. Available at: http://www.nccn.org. Accessed November 21, 2006.
YilmazZ., SahinF.I., KizilkilicE.Conventional and molecular cytogenetic findings of myelodysplastic syndrome patients. Clin Exp Med.2005; 5: 55–59.
9.
PananiA.D., RoussosC.Cytogenetic aspects of adult primary myelodysplastic syndromes: clinical implications. Cancer Lett.2006; 235: 177–190.
10.
GiagounidisA.A., GermingU., StruppC.Prognosis of patients with del(5q) MDS and complex karyotype and the possible role of lenalidomide in this patient subgroup. Ann Hematol.2005; 82: 569–571.
11.
BoultwoodJ., FidlerC., StricksonA.J.Narrowing and genomic annotation of the commonly deleted region of the 5q- syndrome. Blood.2002; 99: 4638–4641.
12.
GiagounidisA.A., GermingU., AulC.Biological and prognostic significance of chromosome 5q deletions in myeloid malignancies. Clin Cancer Res.2006; 12: 5–10.
GiagounidisA.A., GermingU., HaaseS.Clinical, morphological, cytogenetic, and prognostic features of patients with myelodysplastic syndromes and del(5q) including band q31. Leukemia.2004; 18: 113–119.
15.
ChesonB.D., BennettJ.M., KantarjianH.Report of an international working group to standardize response criteria for myelodysplastic syndromes. Blood.2000; 96: 3671–3674.
16.
ListA., KurtinS., RoeD.J.Efficacy of lenalidomide in myelodysplastic syndromes. N Engl J Med.2005; 352: 549–557.
17.
ListA., DewaldG., BennettJ.Lenalidomide in the myelodysplastic syndrome with chromosome 5q deletion. N Engl J Med.2006; 355: 1456–1465.
18.
ListA.F., DewaldG., BennettJ.Results of the MDS-002 and -003 international phase II studies evaluating lenalidomide (CC-5013; Revlimid®) in the treatment of transfusion-dependent patients with myelodysplastic syndrome (MDS). Haematologica.2005; 90(suppl 2): 307a.
19.
Hellstrom-LindbergE., NegrinR., SteinR.Erythroid response to treatment with G-CSF plus erythropoietin for the anaemia of patients with myelodysplastic syndromes: proposal for a predictive model. Br J Haematol.1997; 99: 344–351.
20.
HoweR.B., Porwit-MacDonaldA., WanatR.The WHO classification of MDS does make a difference. Blood.2004; 103: 3265–3270.
21.
SaunthararajahY., NakamuraR., WesleyR.A simple method to predict response to immunosuppressive therapy in patients with myelodysplastic syndrome. Blood.2003; 102: 3025–3027.
22.
SloandE.M., GreenbergP., WuC.Immunosuppressive treatment is associated with durable responses and a survival advantage in younger patients with Int-1 myelodysplastic syndrome. Blood.2005; 106: 707a.
