Oncotarget

Clinical Research Papers:

Outcome of patients treated for myelodysplastic syndromes without deletion 5q after failure of lenalidomide therapy

Thomas Prebet _, Andrea Toma, Thomas Cluzeau, Mikkael A. Sekeres, Norbert Vey, Sophie Park, Najla Al Ali, Marie M. Sugrue, Rami Komrokji, Pierre Fenaux and Steven D. Gore

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Oncotarget. 2017; 8:37866-37874. https://doi.org/10.18632/oncotarget.15200

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Abstract

Thomas Prebet1,2, Andrea Toma2,9,*, Thomas Cluzeau3,*, Mikkael A. Sekeres4, Norbert Vey2,5, Sophie Park2,6, Najla Al Ali3, Marie M. Sugrue8, Rami Komrokji3,*, Pierre Fenaux2,7,* and Steven D. Gore1,*

1 Section of Hematology, Department of Internal Medicine, Yale University, New Haven, CT, USA

2 Groupe Francophone des Myelodysplasies, Hopital Saint Louis, Paris, France

3 Department of Hematology, Moffitt Cancer Center, Tampa, FL, USA

4 Leukemia Program, Cleveland Clinic, Cleveland, OH, USA

5 Departement d’hematologie, Institut Paoli-Calmettes, Marseille, France

6 Clinique Universitaire d’hématologie, CHU Grenoble Alpes, Grenoble, France

7 Service Hematologie Senior, Hopital Saint Louis, Paris, France

8 Celgene Corporation, Summit, NJ, USA

9 Service d’Hematologie, Hopital Cochin, Paris, France

* These authors have contributed equally to this work

Correspondence to:

Thomas Prebet, email:

Keywords: myelodysplasia, outcome, lenalidomide

Received: November 17, 2016 Accepted: November 23, 2016 Published: February 08, 2017

Abstract

Anemia is a key survival prognostic factor in lower-risk myelodysplastic syndromes (MDS). Lenalidomide (LEN) can correct anemia in 25% of MDS patients without deletion 5q (del5q). As this therapy will inevitably fail, understanding the outcome of these patients will facilitate development of subsequent treatment strategies. To answer this question, an international retrospective study focused on LEN-treated lower-risk, non-del5q, MDS patients was performed. We analyzed the overall survival after LEN failure, its prognostic factors and the impact of post LEN treatment options. We included a total of 384 patients. The median overall survival after failure of LEN was 43 months. In multivariate analysis, adverse cytogenetics, excess of blasts at the initiation of LEN, and the type of failure (classified as stable disease, relapse, intolerance, or progression) were the main determinants of outcome. Subsequent therapy with hypomethylating agents was associated with a prolonged survival compared to BSC (median OS= 51m vs. 36m, p=0.01). In conclusion, the survival for non-del5q MDS patients after failure of LEN remains relatively prolonged, though with a wide range. Clinical trial participation remains the recommendation for these patients even if options such as hypomethylating agents may be considered.


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