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Efficacy of lenalidomide in an sAML patient with del 5q relapsing after reduced-intensity allogeneic stem cell transplantation performed in complete remission

Bone Marrow Transplantation volume 45, pages 791–792 (2010)Cite this article

The recent advent of lenalidomide has been a major breakthrough in IPSS low- and intermediate-1-risk myelodysplastic syndrome (MDS) with del 5q syndrome, as this drug leads to RBC transfusion independence in two-thirds of them.1 The kinetics of response to lenalidomide and in vitro studies suggested a selective inhibitory effect of lenalidomide on the clone with 5q deletion.2, 3 However, at least one-third of MDS with del 5q have higher-risk IPSS, that is, IPSS high or intermediate-2. del 5q is also a frequent finding in AML in the elderly. Higher risk and AML with del 5q carry a poor prognosis, due in particular to their poor response to anthracycline-AraC chemotherapy in the case of AML and to azacytidine in the case of MDS.4 In a recent phase II study conducted in 47 patients with high- and intermediate-2-risk MDS with del 5q, 6 of the 9 patients with isolated del 5q achieved CR, whereas only 1 of the patients with one or several chromosomal abnormalities in addition to del 5q responded.5 Finally, in higher-risk MDS (including those with del 5q), allo-SCT remains the only curative option, but the relapse rate remains important after transplantation, especially in the case of the non-myeloablative conditioning regimen. We report the induction of hematological and cytogenetic CR by lenalidomide in a patient with AML and del 5q relapsing after non-myeloablative SCT.

Lenalidomide was started at a dose of 10 mg/day for 21 days every 28 days. After three cycles, the hemoglobin level had increased to 12 g/dl and the patient was in complete hematological remission with partial cytogenetic response (del 5q being still observed in 25% of the cells by FISH analysis). Finally, complete cytogenetic response was achieved after six cycles of lenalidomide. It is noteworthy that marrow chimerism using FISH, using labeled X and Y chromosome probes, increased from 60% donor at the time of relapse to 87% donor at the time of cytogenetic CR and from 60 to 75% in CD3+ cells.

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Author notes

  1. P Martiat and P Fenaux: These authors contributed equally to this work.

Authors and Affiliations

  1. Hôpital Avicenne, Assistance Publique-Hopitaux de Paris, Université Paris 13, Bobigny, France

    L Adès, V Eclache, C Gardin, S Boehrer, G Leroux & P Fenaux

  2. INSERM U848, Institut Gustave Roussy, Villejuif, France

    L Adès, S Boehrer & P Fenaux

  3. Jules Bordet Institute, Brussels, Belgium

    P Martiat

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  1. L Adès
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  2. V Eclache
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Correspondence to L Adès.

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Adès, L., Eclache, V., Gardin, C. et al. Efficacy of lenalidomide in an sAML patient with del 5q relapsing after reduced-intensity allogeneic stem cell transplantation performed in complete remission. Bone Marrow Transplant 45, 791–792 (2010). https://doi.org/10.1038/bmt.2009.225

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