Higher-risk myelodysplastic syndromes with del(5q): is sequential azacitidine–lenalidomide combination the way to go?

Abstract

Evaluation of: Platzbecker U, Braulke F, Kündgen A et al. Sequential combination of azacitidine and lenalidomide in del(5q) higher-risk myelodysplastic syndromes or acute myeloid leukemia: a Phase I study. Leukemia doi:10.1038/leu.2013.26 (2013) (Epub ahead of print).

High-risk myelodysplastic syndromes (HR-MDS) and acute myeloid leukemia (AML) with deletions of long arm of chromosome 5 (del[5q]) are characterized by rapid progression and poor survival. The majority of these patients are elderly with comorbidities, therefore limiting the use of intensive therapies which, even if used, unfortunately yield low responses. While azacitidine prolongs survival in patients with HR-MDS by a median of 9.5 months, responses only occur in less than half of the patients, and azacitidine therapy is not curative, with most patients relapsing within 2 years. Therefore, strategies to improve outcomes in these patients are needed. Azacitidine and lenalidomide both have meaningful single-agent clinical activity in HR-MDS and AML with del(5q). Early-phase trials in HR-MDS without del(5q) suggest increased activity with a concurrent azacitidine–lenalidomide combination. In this article, we review the results of a Phase I trial of a sequential azacitidine–lenalidomide combination approach in patients with HR-MDS and AML with del(5q) abnormality.

Keywords::

• azacitidine
• combination therapy
• del(5q)
• lenalidomide
• myelodysplastic syndrome

Financial & competing interests disclosure

RS Komrokji has served on the speakers’ bureau for Celgene, and SD Gore owned stocks in Celgene until August 2011. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

No writing assistance was utilized in the production of this manuscript.