Outcome of Myelodysplastic Syndrome (MDS) with and without
Chromosome 5 Abnormalities
Slides from the journal articles and transcribed comments from recent interviews with
Gail J Roboz, MD (10/6/09), Steven D Gore, MD (10/8/09) and Hagop M Kantarjian, MD (10/17/09) below
Presentations discussed in this issue:
Kantarjian H et al. The heterogeneous prognosis of patients with myelodysplastic syndrome and chromosome 5 abnormalities: How does it relate to the original lenalidomide experience in MDS? Cancer 2009;[Epub ahead of print]. Abstract
Raza A et al. Phase 2 study of lenalidomide in transfusion-dependent, low-risk, and intermediate-1 risk myelodysplastic syndromes with karyotypes other than deletion 5q. Blood 2008;111(1):86-93. Abstract
GAIL J ROBOZ, MD: The Kantarjian Cancer 2009 paper is a good review paper for clinicians. There’s been a lot of confusion in the community about this issue and questions whether all patients with a 5q minus abnormality benefit from lenalidomide. This paper is helpful in clarifying that that may not be the case. It goes through in a clinically meaningful way what happens to these patients and which ones are likely to benefit from lenalidomide. There are patients with a dismal prognosis who carry a 5q minus, and there are patients who have prognosis that’s measured in many years. It is important to recognize that all 5q minus is not the same. The Raza study showed that it is possible for some patients who do not have the 5q deletion to have a hematologic improvement in response to lenalidomide. Lenalidomide will give about a 25 percent response rate and can be considered for anemic patients at low and intermediate 1 risk with neutrophils > 500 and platelets > 50,000 who haven't responded to growth factors. Response can be assessed within about 12 weeks.
STEVEN D GORE, MD: This Kantarjian paper is useful in that it describes a spectrum of biological behaviors of patients with myelodysplastic syndrome (MDS) who have deletion of chromosome 5q or monosomy-5. It shows that there is heterogeneity in the survival outcomes of the group of patients with chromosome 5 abnormalities. The Raza study population was an unusual population of patients with transfusion-dependent MDS in that they had neutrophils of at least 500 and platelets of at least 50,000, but the study does suggest that among those patients, 25 percent will become transfusion independent in response to lenalidomide therapy. One would take this information and know that it is an option, albeit not a fabulous one, for such patients. You will find out within two or three months if the patient is going to respond.
HAGOP M KANTARJIAN, MD: The only scenario in which administering lenalidomide to patients without chromosome 5 abnormalities may work is with patients with low-risk MDS who are transfusion dependent. In that setting, usually the transfusion independence rate is about 25 percent. If you have a patient with low-risk MDS to whom you have administered growth factors for red blood cell transfusion dependence without response, you can try lenalidomide for a short period of time. I don’t think it is unreasonable, and we do it quite often.
Dr Roboz is Associate Professor of Medicine and Director of the Leukemia Program at Weill Medical College of Cornell University at NewYork-Presbyterian Hospital in New York, New York.
Dr Gore is Professor of Oncology at Johns Hopkins University in Baltimore, Maryland.
Dr Kantarjian is Chairman and Professor of the Leukemia Department at The University of Texas MD Anderson Cancer Center in Houston, Texas.