Sudden acute leukemia transformation in a MDS patient with del(5q) in complete cytogenetic remission after lenalidomide.

High proportion of del(5q) myelodysplastic (MDS) patients achieves transfusion independence and complete cytogenetic remission following treatment with lenalidomide, a thalidomide analogue with anti-angiogenetic, immunomodulating and cytotoxic effects [1]. Lenalidomide was approved in 2005 by FDA for the treatment of MDS patients with del(5q), but little is known about the long-term outcome of these patients. Recently, Gohring et al. [2] reported the follow-up of 42 patients treated with lenalidomide for a median period of 40 months: 36% of them progressed to acute leukemia (AML) with 87% showing clonal cytogenetic evolution in addition to del(5q). However, patients who had obtained erythroid and/or cytogenetic responses displayed a significantly decreased risk of progression at 5 years compared to non-responders [2] G. Gohring, A. Giagounidis, G. Busche, H.H. Kreipe, M. Zimmermann and E. Hellstrom-Lindberg, et al. Patients with del(5q) MDS who fail to achieve sustained erythroid or cytogenetic remission after treatment with lenalidomide have an increased risk for clonal evolution and AML progression. Ann Hematol, 89 (2010), pp. 365–374. | View Record in Scopus | | Full Text via CrossRef | Cited By in Scopus (13)[2]. Here we describe a MDS patient with del(5q) who achieved erythroid and stable complete cytogenetic remission with lenalidomide, but developed sudden AML transformation after 16 months of treatment