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Long-Term Response in a Patient with del(5q) Myelodysplastic Syndrome Who Discontinued Lenalidomide and Obtained a Good Response and Tolerance to Rechallenge

BACKGROUND: The introduction of the immunomodulatory drug lenalidomide has revolutionized the treatment of patients with myelodysplastic syndromes (MDS) and deletion of the long arm of chromosome 5. Treatment with lenalidomide results in transfusion independence in the majority of patients, but some...

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Autores principales: Pisani, Francesco, Orlandi, Giulia, Merola, Roberta
Formato: Online Artículo Texto
Lenguaje:English
Publicado: S. Karger AG 2014
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4036206/
https://www.ncbi.nlm.nih.gov/pubmed/24926257
http://dx.doi.org/10.1159/000362643
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author Pisani, Francesco
Orlandi, Giulia
Merola, Roberta
author_facet Pisani, Francesco
Orlandi, Giulia
Merola, Roberta
author_sort Pisani, Francesco
collection PubMed
description BACKGROUND: The introduction of the immunomodulatory drug lenalidomide has revolutionized the treatment of patients with myelodysplastic syndromes (MDS) and deletion of the long arm of chromosome 5. Treatment with lenalidomide results in transfusion independence in the majority of patients, but some questions remain unresolved, among them the duration of treatment. Moreover, a number of unexpected long-term remissions in patients who stopped lenalidomide for various reasons have been observed. CASE REPORT: We report the case of a 60-year-old Caucasian male with deletion of the long arm of chromosome 5 and International Prognostic Scoring System (IPSS)-defined low-risk MDS who was treated with lenalidomide, achieving complete cytogenetic remission and erythroid response. After tapering off and interrupting the treatment, the patient relapsed and showed a new response by lenalidomide retreatment. Six years after the initial treatment, we registered a durable erythroid long-term response and good tolerance, but there was no evidence of a very profound cytogenetic response compared to using lenalidomide as a first-line treatment. Cytogenetic and fluorescence in situ hybridization together with hemoglobin level, mean corpuscular volume (MCV) and vitamin B(12) level helped us to monitor the patient response; during the various phases of lenalidomide treatment, MCV and vitamin B(12) normalization correlated with good response. CONCLUSION: Lenalidomide interruption and rechallenge in some 5q– MDS patients, with low risk according to the IPSS, is safe and feasible but does not result in a profound cytogenetic response.
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spelling pubmed-40362062014-06-12 Long-Term Response in a Patient with del(5q) Myelodysplastic Syndrome Who Discontinued Lenalidomide and Obtained a Good Response and Tolerance to Rechallenge Pisani, Francesco Orlandi, Giulia Merola, Roberta Case Rep Oncol Published online: April, 2014 BACKGROUND: The introduction of the immunomodulatory drug lenalidomide has revolutionized the treatment of patients with myelodysplastic syndromes (MDS) and deletion of the long arm of chromosome 5. Treatment with lenalidomide results in transfusion independence in the majority of patients, but some questions remain unresolved, among them the duration of treatment. Moreover, a number of unexpected long-term remissions in patients who stopped lenalidomide for various reasons have been observed. CASE REPORT: We report the case of a 60-year-old Caucasian male with deletion of the long arm of chromosome 5 and International Prognostic Scoring System (IPSS)-defined low-risk MDS who was treated with lenalidomide, achieving complete cytogenetic remission and erythroid response. After tapering off and interrupting the treatment, the patient relapsed and showed a new response by lenalidomide retreatment. Six years after the initial treatment, we registered a durable erythroid long-term response and good tolerance, but there was no evidence of a very profound cytogenetic response compared to using lenalidomide as a first-line treatment. Cytogenetic and fluorescence in situ hybridization together with hemoglobin level, mean corpuscular volume (MCV) and vitamin B(12) level helped us to monitor the patient response; during the various phases of lenalidomide treatment, MCV and vitamin B(12) normalization correlated with good response. CONCLUSION: Lenalidomide interruption and rechallenge in some 5q– MDS patients, with low risk according to the IPSS, is safe and feasible but does not result in a profound cytogenetic response. S. Karger AG 2014-04-25 /pmc/articles/PMC4036206/ /pubmed/24926257 http://dx.doi.org/10.1159/000362643 Text en Copyright © 2014 by S. Karger AG, Basel http://creativecommons.org/licenses/by-nc/3.0/ This is an Open Access article licensed under the terms of the Creative Commons Attribution-NonCommercial 3.0 Unported license (CC BY-NC) (www.karger.com/OA-license), applicable to the online version of the article only. Users may download, print and share this work on the Internet for noncommercial purposes only, provided the original work is properly cited, and a link to the original work on http://www.karger.com and the terms of this license are included in any shared versions.
spellingShingle Published online: April, 2014
Pisani, Francesco
Orlandi, Giulia
Merola, Roberta
Long-Term Response in a Patient with del(5q) Myelodysplastic Syndrome Who Discontinued Lenalidomide and Obtained a Good Response and Tolerance to Rechallenge
title Long-Term Response in a Patient with del(5q) Myelodysplastic Syndrome Who Discontinued Lenalidomide and Obtained a Good Response and Tolerance to Rechallenge
title_full Long-Term Response in a Patient with del(5q) Myelodysplastic Syndrome Who Discontinued Lenalidomide and Obtained a Good Response and Tolerance to Rechallenge
title_fullStr Long-Term Response in a Patient with del(5q) Myelodysplastic Syndrome Who Discontinued Lenalidomide and Obtained a Good Response and Tolerance to Rechallenge
title_full_unstemmed Long-Term Response in a Patient with del(5q) Myelodysplastic Syndrome Who Discontinued Lenalidomide and Obtained a Good Response and Tolerance to Rechallenge
title_short Long-Term Response in a Patient with del(5q) Myelodysplastic Syndrome Who Discontinued Lenalidomide and Obtained a Good Response and Tolerance to Rechallenge
title_sort long-term response in a patient with del(5q) myelodysplastic syndrome who discontinued lenalidomide and obtained a good response and tolerance to rechallenge
topic Published online: April, 2014
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4036206/
https://www.ncbi.nlm.nih.gov/pubmed/24926257
http://dx.doi.org/10.1159/000362643
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