Revlimid for AML – pro
Revlimid is a derivative of thalidomide with less toxic side effects. A multicenter U.S. trial has reported hematologic activity of Revlimid in patients with myelodysplastic syndromes (MDS). The U.S. Food and Drug Administration has approved Revlimid for the treatment of low- to intermediate-risk MDS in patients who are transfusion-dependent associated with a 5q cytogenetic abnormality, with or without other cytogenetic abnormalities. This drug has been studies for maintenance and for induction, the latter with other agents, but randomized studies are lacking. After several case reports, a Phase II study examined lenalidomide in previously untreated older AML patients (age >60 years) with deletion 5q. In addition, Chen et al studied single-agent lenalidomide in 18 relapsed/refractory AML patients and nine high-risk MDS patients with the 5q deletion. Most patients had complex cytogenetics. Two AML patients (11%) achieved CR or CR without platelet recovery. Interestingly, both of these patients had a trisomy 8 cytogenetic abnormality in a clone separate from the 5q deletion clone. Of note, no responses were observed in patients with complex cytogenetics. Given the comparatively modest efficacy of lenalidomide in higher-risk MDS and AML, this agent is being explored in combinations with other agents. There does not appear to be sufficient evidence to sue it for maintenance in this situation. REFERENCES : [NC-DOI requires current references (i.e., w/in the past 3 years). If there are none available, then we must note that the references, although old, “speak to the current standard of care.”] [References cannot be used if they took effect AFTER the date of service; e.g., if DOS was 2/1/17, then we can’t use a reference that was published
Pollyea DA Sekeres MA, Gundacker H, Lancet J, et al. A phase 2 study of lenalidomide monotherapy in patients with deletion 5q acute myeloid leukemia: Southwest Oncology Group Study S0605. Blood. 2011;118:523–528. R. S. Komrokji A. F. List, Short- and long-term benefits of lenalidomide treatment in patients with lower-risk del(5q) myelodysplastic syndromes. Annals of Oncology, Volume 27, Issue 1, 1 January 2016, Pages 62–68,