Myelodysplastic syndrome
ICD-10 D46 · ICD-11 2A3Z

Treatment of Lower-Risk MDS with del(5q) After Lenalidomide Failure

This protocol addresses lower-risk myelodysplastic syndrome (IPSS-R up to 3.5) with symptomatic, transfusion-dependent anaemia and del(5q), in patients where an initial course of Lenalidomide did not achieve the expected goals.

Clinical Scenario

Lower-risk MDS (IPSS-R up to 3.5) encompasses very low-, low-, and part of intermediate-risk patients. When del(5q) is present alongside symptomatic anaemia — generally when haemoglobin falls below 10 g/dl and transfusion dependence develops — Lenalidomide is established as the most effective first-line drug. This protocol applies once that first-line course has been tried.

Previous Treatment — Failure Condition

The preceding treatment line used Lenalidomide. Escalation to this protocol is indicated when that therapy did not achieve red blood cell transfusion independence or an adequate cytogenetic response.

Treatment Approach (Partial Overview)

After Lenalidomide failure in this setting, the protocol involves a hypomethylating agent-based approach — and, whenever the clinical situation permits, consideration of allogeneic stem cell transplantation. The full regimen, decision criteria, and sequencing are available in the complete protocol below.

Instant Access to Structured Evidence-Based Regimens

References

DOI: 10.1016/j.annonc.2020.11.002

  1. For therapeutic purposes, the term 'lower-risk' MDS generally applies to cases with IPSS-R up to 3.5 including very low- and low-risk and part of intermediate-risk IPSS-R patients.
  2. Symptomatic anaemia (generally if Hb <10 g/dl)
  3. Del(5q)
  4. For transfusion-dependent anaemia of lower-risk MDS with del(5q), LEN is the most effective drug [I, A].
  5. Patients with TP53 gene mutation may have a particularly poor outcome and are considered candidates for approaches that have demonstrated a survival benefit in higher-risk MDS, including HMAs, and whenever possible, allo-SCT [IV, B].
View source ↗