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Blood, 1 January 2008, Vol. 111, No. 1, pp. 86-93. Prepublished online as a Blood First Edition Paper on September 24, 2007; DOI 10.1182/blood-2007-01-068833.
CLINICAL TRIALS AND OBSERVATIONS Phase 2 study of lenalidomide in transfusion-dependent, low-risk, and intermediate-1–risk myelodysplastic syndromes with karyotypes other than deletion 5q1 Rush University Medical Center, Chicago, IL; 2 Florida Cancer Specialists, Fort Myers; 3 Weill Medical College of Cornell University, New York, NY; 4 Mayo Clinic, Rochester, MN; 5 James P. Wilmot Cancer Center, University of Rochester Medical Center, NY; 6 Fred Hutchinson Cancer Research Center, Seattle, WA; 7 Eisenhower Medical Center, Rancho Mirage, CA; 8 Karmanos Cancer Institute, Wayne State University School of Medicine, Detroit, MI; 9 Dana-Farber Cancer Institute, Boston, MA; 10 Stanford University Medical Center, CA; 11 Oregon Health and Sciences University, Portland; 12 Memorial Sloan-Kettering Cancer Center, New York, NY; 13 M. D. Anderson Cancer Center, Houston, TX; 14 Celgene, Summit, NJ; and 15 H. Lee Moffitt Cancer Center, Tampa, FL
Lenalidomide is approved for red blood cell (RBC) transfusion-dependent anemia due to low or intermediate-1 (int-1) risk myelodysplastic syndromes (MDSs) associated with a chromosome 5q deletion with or without additional cytogenetic abnormalities. We report results of a multicenter, phase 2 trial evaluating lenalidomide therapy for transfusion-dependent patients with low- or int-1–risk MDS without deletion 5q. Eligible patients had 50 000/mm3 or more platelets and required 2 U or more RBCs within the previous 8 weeks; 214 patients received 10 mg oral lenalidomide daily or 10 mg on days 1 to 21 of a 28-day cycle. The most common grade 3/4 adverse events were neutropenia (30%) and thrombocytopenia (25%). Using an intention-to-treat analysis, 56 (26%) patients achieved transfusion independence (TI) after a median of 4.8 weeks of treatment with a median duration of TI of 41.0 weeks. In patients who achieved TI, the median rise in hemoglobin was 32 g/L (3.2 g/dL; range, 10-98 g/L [1.0-9.8 g/dL]) from baseline. A 50% or greater reduction in transfusion requirement occurred in 37 additional patients, yielding a 43% overall rate of hematologic improvement (TI response +||
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