Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

  • Letter to the Editor
  • Published:

Remitting activity of lenalidomide in treatment-induced myelodysplastic syndrome

Leukemia volume 21, pages 1576–1578 (2007)Cite this article

Lenalidomide (Revlimid, Celgene) is an immunomodulatory agent with both erythropoetic and cytogenetic remitting activity in patients with primary myelodysplastic syndrome (MDS) associated with interstitial deletion of chromosome 5q. MDS secondary to chemotherapy or ionizing radiation is historically associated with an aggressive natural history and unfavorable prognosis with resistance to standard therapeutic agents.1 Here we report two patients with secondary MDS and deletion 5q who achieved hematologic or cytogenetic responses following treatment with lenalidomide.

In the first case, a seventy-four-year-old male with secondary MDS was initially diagnosed in June 1999 with adenocarcinoma of the gastroesophageal junction. He underwent esophagectomy with gastric pull through and surgical staging of T3 N1 M0 disease (six of nine lymph nodes involved). He received 45 Gy post-operative radiotherapy and aggressive local regional extracorporeal perfusional chemotherapy with mitomycin-C, interleukin-2, epirubicin, etoposide, 5–fluorouracil, leucovorin and methotrexate. He has remained in a sustained complete remission from the adenocarcinoma. However, he developed mild thrombocytopenia in 2001, followed by progressive anemia and thrombocytopenia in early 2006. By February 2006, he had a hemoglobin level of 8.8 g/dl with a white blood cell count of 2400/μl and platelet count of 54 000/l. Bone marrow aspirate and biopsy were performed in March 2003 demonstrating a relatively hypocellular marrow with trilineage dysplasia and a myeloid/erythroid ratio of 1:1.2. The myeloblast count was 15% with rare ringed sideroblasts and cytogenetic studies demonstrated a 5q 13–33 deletion in 20 of 23 metaphases analyzed. He initially received treatment with recombinant erythropoietin 10 000 units three times a week without improvement and was dependent on red blood cell transfusion. A repeat bone marrow biopsy performed in April 2006 showed no change in medullary blast percentage (16%) or karyotype. The patient started treatment with lenalidomide at a dose of 10 mg daily in June 2006. He received treatment for 10 consecutive days followed by a 7-day treatment hiatus for pruritic rash before resuming lenalidomide at 5 mg daily dose. After 2 months of treatment, he experienced a progressive rise in hemoglobin level (>4 g/dl increase) and moderate improvement in platelet count (Table 1). He has been maintained on 5 mg daily dose thereafter. Bone marrow aspirate and biopsy repeated on 22 August 2006 showed no evidence of residual dysplasia with 0% blasts and cytogenetic studies demonstrating a normal male karyotype in each of the 20 metaphases analyzed. His latest red blood cell transfusion was administered on June 2006 with the most recent complete blood count recorded on 22 December 2006 showing a white blood cell count of 2300/μl with 53% neutrophils, hemoglobin level of 12.4 gm/dl with an MCV of 104 and a platelet count of 99 000/μl.

Table 1 Hematologic response to lenalidomide in Case 1
Full size table

This is a preview of subscription content, access via your institution

Access options

Buy this article

  • Purchase on Springer Link
  • Instant access to full article PDF
Buy now

Prices may be subject to local taxes which are calculated during checkout

References

  1. Shali W, Helias C, Fohrer C, Struskei S, Gervais C, Falkenrodt A et al. Cytogenetic studies of a series of 43 consecutive secondary myelodysplastic syndromes/acute myeloid leukemias: conventional cytogenetics, FISH, and multiplex FISH. Cancer Genet Cytogenet 2006; 168: 133–145.

    Article  CAS  PubMed  Google Scholar 

  2. List AF, Kurtin S, Roe D, Buresh A, Mahadevan D, Fuchs D et al. Efficacy of lenalidomide in myelodypslastic syndromes. N Engl J Med 2005; 352: 549–557.

    Article  CAS  PubMed  Google Scholar 

  3. List AF, Dewald G, Bennett J, Giagounidis A, Raza A, Feldman E et al. Lenalidomide in the myelodysplastic syndrome with chromosome 5q deletion. N Eng J Med 2006; 355: 1456–1465.

    Article  CAS  Google Scholar 

  4. Pedersen-Bjergaard J, Andersen MK, Chrstiansen DH . Therapy-related acute myeloid leukemia and myelodysplasia after high-dose chemotherapy and autologous stem cell transplantation. Blood 2000; 95: 3273–3279.

    CAS  PubMed  Google Scholar 

  5. Darrington DL, Vose JM, Anderson JR, Bierman PJ, Bishop MR, Chan WC et al. Incidence and characterization of secondary myelodysplastic syndrome and acute myelogenous leukemia following high-dose chemoradiotherapy and autologous stem-cell transplantation for lymphoid malignancies. J Clin Oncol 1994; 12: 2527–2534.

    Article  CAS  PubMed  Google Scholar 

  6. Hake CR, Graubert TA, Fenske TS . Does Autologus transplantation directly increase the risk of secondary leukemia in lymphoma patients? Bone Marrow Transplant 2006 [Epub ahead of print].

Download references

Author information

Authors and Affiliations

  1. Malignant Hematology, Moffitt Cancer Center and Research Institute, Magnolia Drive, Tampa, FL, USA

    M Melchert & A List

  2. Kansas City Blood and Marrow Transplant Program, Suite, Kansas, MO, USA. E-mail: melcheme@moffitt.usf.edu,

    C Williams

Authors
  1. M Melchert
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. C Williams
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. A List
    View author publications

    You can also search for this author in PubMed Google Scholar

Rights and permissions

Reprints and permissions

About this article

Cite this article

Melchert, M., Williams, C. & List, A. Remitting activity of lenalidomide in treatment-induced myelodysplastic syndrome. Leukemia 21, 1576–1578 (2007). https://doi.org/10.1038/sj.leu.2404677

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1038/sj.leu.2404677

This article is cited by

Search

Advanced search

Quick links