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  • Title: Transfusion independence after lenalidomide discontinuation in patients with del(5q) myelodysplastic neoplasm: a HARMONY Alliance study.
    Author: Crisà E, Mora E, Germing U, Bally C, Diez Campelo M, Myllymäki M, Jädersten M, Komrokji R, Platzbecker U, Haase D, Hofmann WK, Al Ali NH, Barraco D, Bargay JJ, Bernal T, López Cadenas F, Calvisi A, Capodanno I, Cerrano M, Ciancia R, Crugnola M, Kündgen A, Finelli C, Fozza C, Frairia C, Freja E, Ganster C, Kubasch AS, Jimenez MJ, Latagliata R, Hernandez Mohedo F, Molero A, Vara Pampliega M, Perez CA, Pietrantuono G, Poloni A, Pomares H, Recasens V, Rüfer A, Signori A, Hellstrom-Lindberg E, Fenaux P, Sanz G, Santini V.
    Journal: Leukemia; 2024 Oct; 38(10):2259-2265. PubMed ID: 39103678.
    Abstract:
    Lenalidomide (LEN) can induce red blood cell-transfusion independence (RBC-TI) in 60-70% of del(5q) myelodysplastic neoplasm (MDS) patients. Current recommendation is to continue LEN in responding patients until failure or progression, with likelihood of toxicity and a high cost for healthcare systems. This HARMONY Alliance study investigated the outcome of MDS del(5q) patients who discontinued LEN while RBC-transfusion independent. We enrolled 118 patients with IPSS-R low-intermediate risk. Seventy patients (59%) discontinued LEN for intolerance, 38 (32%) per their physician decision, nine (8%) per their own decision and one (1%) for unknown reasons. After a median follow-up of 49 months from discontinuation, 50/118 patients lost RBC-TI and 22/30 who underwent cytogenetic re-evaluation lost complete cytogenetic response. The median RBC-TI duration was 56 months. In multivariate analysis, RBC-TI duration after LEN discontinuation correlated with low transfusion burden before LEN therapy, treatment ≥ 12 LEN cycles, younger age and higher Hb level at LEN withdrawal. Forty-eight patients were re-treated with LEN for loss of response and 28 achieved again RBC-TI. These data show that stopping LEN therapy in MDS del(5q) patients who reached RBC-TI allows prolonged maintenance of TI in a large subset of patients.
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