Outcome of patients treated for myelodysplastic syndromes without deletion 5q after failure of lenalidomide therapy.
Anemia is a key survival prognostic factor in lower-risk myelodysplastic syndromes (MDS). Lenalidomide (LEN) can correct anemia in 25% of MDS patients without deletion 5q (del5q). As this therapy will inevitably fail, understanding the outcome of these patients will facilitate development of subsequent treatment strategies. To answer this question, an international retrospective study focused on LEN-treated lower-risk, non-del5q, MDS patients was performed. We analyzed the overall survival after LEN failure, its prognostic factors and the impact of post LEN treatment options. We included a total of 384 patients. The median overall survival after failure of LEN was 43 months. In multivariate analysis, adverse cytogenetics, excess of blasts at the initiation of LEN, and the type of failure (classified as stable disease, relapse, intolerance, or progression) were the main determinants of outcome. Subsequent therapy with hypomethylating agents was associated with a prolonged survival compared to BSC (median OS= 51m vs. 36m, p=0.01). In conclusion, the survival for non-del5q MDS patients after failure of LEN remains relatively prolonged, though with a wide range. Clinical trial participation remains the recommendation for these patients even if options such as hypomethylating agents may be considered.
Section of Hematology, Department of Internal Medicine, Yale University, New Haven, CT, USA.|Groupe Francophone des Myelodysplasies, Hopital Saint Louis, Paris, France.
Thomas
T
Prebet
Groupe Francophone des Myelodysplasies, Hopital Saint Louis, Paris, France.|Service d'Hematologie, Hopital Cochin, Paris, France.
Andrea
A
Toma
Department of Hematology, Moffitt Cancer Center, Tampa, FL, USA.
Thomas
T
Cluzeau
Leukemia Program, Cleveland Clinic Cleveland, OH, USA.
Mikkael A
MA
Sekeres
Groupe Francophone des Myelodysplasies, Hopital Saint Louis, Paris, France.|Departement d'hematologie, Institut Paoli-Calmettes, Marseille, France.
Norbert
N
Vey
Groupe Francophone des Myelodysplasies, Hopital Saint Louis, Paris, France.|Clinique Universitaire d'hématologie, CHU Grenoble Alpes, Grenoble, France.
Sophie
S
Park
Department of Hematology, Moffitt Cancer Center, Tampa, FL, USA.
Najla
N
Al Ali
Celgene Corporation, Summit, NJ, USA.
Marie M
MM
Sugrue
Department of Hematology, Moffitt Cancer Center, Tampa, FL, USA.
Rami
R
Komrokji
Groupe Francophone des Myelodysplasies, Hopital Saint Louis, Paris, France.|Service Hematologie Senior, Hopital Saint Louis, Paris, France.
Pierre
P
Fenaux
Section of Hematology, Department of Internal Medicine, Yale University, New Haven, CT, USA.
Steven D
SD
Gore
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000740:Anemia / Q000188:drug therapy / Q000209:etiology*; D020533:Angiogenesis Inhibitors / Q000494:pharmacology / Q000627:therapeutic use*; D002872:Chromosome Deletion; D002895:Chromosomes, Human, Pair 5 / Q000378:metabolism*; D018450:Disease Progression; D005260:Female; D006801:Humans; D000077269:Lenalidomide; D008875:Middle Aged; D009190:Myelodysplastic Syndromes / Q000188:drug therapy* / Q000235:genetics / Q000401:mortality; D011379:Prognosis; D016019:Survival Analysis; D013792:Thalidomide / Q000031:analogs & derivatives* / Q000494:pharmacology / Q000627:therapeutic use; D016896:Treatment Outcome; D055815:Young Adult
D020533:Angiogenesis Inhibitors; D013792:Thalidomide; D000077269:Lenalidomide
lenalidomide; myelodysplasia; outcome