Lenalidomide Treatment for Lower Risk Nondeletion 5q Myelodysplastic Syndromes Patients Yields Higher Response Rates When Used Before Azacitidine.

Abstract

Lenalidomide and azanucleosides are commonly used to treat anemic patients with lower-risk myelodysplastic syndromes (LR-MDS) without chromosome 5q deletion (non-del5q) after failure of treatment with erythropoiesis-stimulating agents (ESAs). Nonetheless, response rates to lenalidomide after azanucleosides treatment failure and their optimal sequencing after failure of treatment with ESAs is unknown. We identified patients with LR-MDS in the Moffitt Cancer Center Clinical Database who received lenalidomide and azacitidine after ESA treatment failure. Rates of erythroid hematologic improvement (HI-E) in patients who received lenalidomide first followed by azacitidine (group 1) and those who received lenalidomide after azacitidine (group 2) were examined according to the International Working Group 2006 criteria. Sixty-three patients (37 in group 1 and 26 in group 2) were identified. The HI-E rate with lenalidomide as first-line therapy was 38% versus only 12% when lenalidomide was used as second-line therapy (P= .04). There were no significant differences in overall survival (OS; median OS, 104 vs. 87 months, respectively; P= .55), rates of leukemic progression, or in HI-E rates after azacitidine use (38% when azacitidine was used after lenalidomide vs. 35% when azacitidine was administered before lenalidomide, P= .69). Lenalidomide appears to yield a higher HI-E rate in non-del5q LR-MDS when used as first-line therapy after ESA treatments failure. If validated in larger cohorts, lenalidomide rather than azacitidine should be considered for first-line therapy after ESA treatment failure.