Lenalidomide Can Replace Blood Transfusions in Bone Marrow Disorder
May 18, 2005 - 1:44:38 AM

A new study reports that the drug lenalidomide (RevLimid) can help some patients with myelodysplastic syndromes (MDS) avoid the need for blood transfusions, and even reduce or eliminate the genetic abnormality that characterizes the disease in this subset of patients.

Lenalidomide is an anti-angiogenic agent that is similar to thalidomide.

Myelodysplastic syndromes are a group of cancers in which the bone marrow does not make enough mature, functional blood cells. Patients commonly undergo blood transfusions every eight weeks to manage symptoms of anemia and fatigue caused by low red blood cell counts. MDS is the most common cancer of the blood in adults ­ more common than leukemia ­ affecting 40,000 to 50,000 Americans every year.

"Lenalidomide is a breakthrough for patients with MDS. This is the first effective therapy for this specific subtype of disease," said lead author Alan F. List, MD, Professor of Medicine at the H. Lee Moffitt Cancer Center in Tampa, Florida. Lenalidomide, which is taken orally, may work against MDS by inhibiting angiogenesis (the growth of blood vessels that tumor cancers need to grow), boosting the body's immune response against cancer, and enhancing red blood cell development.

Investigators examined the response to 10 mg of once-daily lenalidomide among 146 patients with MDS who relied on blood transfusions. All patients had a deletion of a region of genetic material on the long "q" arm of chromosome 5 ("del5q"). The trial was initiated in July 2003, and monitoring is ongoing. All patients who responded to the drug are continuing to take it as long as it remains effective.

After 24 weeks, 64% of patients responded to lenalidomide and did not need a transfusion. Seventy-six percent of those who responded experienced a reduction in the number of marrow cells that had the del5q abnormality, and 55% of responders had no evidence of the del5q abnormality. After a median follow-up of 9.3 months, 91% of responding patients continued to show a response to lenalidomide. The most common side effects were lowering of the white blood cell count (39% of patients) and platelet count (35%), which necessitated interruption of treatment or reduction of lenalidomide dose.

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