Department of Hematologic Oncology and Blood Disorders, Leukemia Program, Cleveland Clinic Taussig Cancer Institute, Cleveland, Ohio 44195, USA.
Am J Hematol. 2011 Jan;86(1):102-3. doi: 10.1002/ajh.21891.
Lenalidomide and azacitidine are active in MDS patients, and may complement each other by targeting the bone marrow microenvironment and the malignant clone. A recent Phase I trial testing the lenalidomide and azacitidine combination yielded encouraging results; however, lenalidomide’s contribution was unclear. In this study, 18 higher-risk MDS patients were treated with the combination for seven cycles, after which lenalidomide was discontinued in eight patients who achieved a complete response, with azacitidine monotherapy continuing until disease progression. We report on three patients who relapsed on monotherapy with excess blasts at 12, 19, and 24 months, in whom lenalidomide was then resumed in combination with azacitidine. Each patient, one with normal cytogenetics at relapse; one with a 18 abnormality; and one with del(4q25), recaptured a complete response that was sustained for 5, 7, and 7+ months. We conclude that the addition of lenalidomide to azacitidine provides additional clinical benefit over azacitidine monotherapy.
来那度胺和阿扎胞苷对 MDS 患者有效，可能通过靶向骨髓微环境和恶性克隆相互补充。最近一项测试来那度胺和阿扎胞苷联合用药的 I 期试验取得了令人鼓舞的结果；然而，来那度胺的作用尚不清楚。在这项研究中，18 例高危 MDS 患者接受了 7 个周期的联合治疗，在 8 例完全缓解的患者中停用了来那度胺，而阿扎胞苷单药治疗继续进行，直到疾病进展。我们报告了 3 例在单药治疗中复发的患者，在 12、19 和 24 个月时出现过多的原始细胞，然后重新开始用来那度胺联合阿扎胞苷治疗。在这 3 例患者中，1 例在复发时细胞遗传学正常，1 例有 18 号染色体异常，1 例有 del(4q25)，均再次获得完全缓解，持续缓解时间分别为 5、7 和 7+个月。我们的结论是，来那度胺联合阿扎胞苷可提供比阿扎胞苷单药治疗更显著的临床获益。
