MDS Unit, Hematology, AOU Careggi, University of Florence, Florence, Italy.
Instituto Português de Oncologia de Lisboa Francisco Gentil, Lisbon, Portugal.
Leuk Lymphoma. 2020 Jun;61(6):1475-1483. doi: 10.1080/10428194.2020.1719088. Epub 2020 Feb 17.
In the randomized, phase 3, MDS-005 study (NCT01029262), lenalidomide-induced red blood cell transfusion independence (RBC-TI) in 27% of transfusion-dependent patients with lower-risk non-del(5q) myelodysplastic syndromes (MDS) ineligible for or refractory to erythropoiesis-stimulating agents. To determine the influence of erythropoietin (EPO) level on response, 155 patients treated with lenalidomide in MDS-005 were categorized into four groups by baseline EPO level. The EPO >500 mU/mL group had higher RBC transfusion burden and the lowest proportion of patients with ring sideroblasts ≥15% versus lower EPO groups. Achievement of RBC-TI ≥8 weeks inversely correlated with EPO level, ranging from 42.5 to 15.5%. EPO level did not affect erythroid hematologic improvement response (36.2-44.4%). This analysis suggests patients with lower EPO levels experience the strongest benefit from lenalidomide. Although meaningful improvements were observed in some patients with EPO level >500 mU/mL, new treatments are needed for this population.
在这项随机、3 期 MDS-005 研究（NCT01029262）中，在不适合或对红细胞生成刺激剂有抗药性的低危非-del(5q)骨髓增生异常综合征（MDS）输血依赖性患者中，来那度胺诱导红细胞输血独立性（RBC-TI）的比例为 27%。为了确定促红细胞生成素（EPO）水平对反应的影响，MDS-005 中接受来那度胺治疗的 155 例患者根据基线 EPO 水平分为四组。EPO＞500mU/mL 组的红细胞输血负担较高，≥15%环形铁幼粒细胞的患者比例最低，而 EPO 水平较低的组则相反。≥8 周达到 RBC-TI 的患者比例与 EPO 水平呈反比，范围为 42.5%至 15.5%。EPO 水平不影响红细胞血液学改善反应（36.2%-44.4%）。这项分析表明，EPO 水平较低的患者从来那度胺中获益最大。尽管在 EPO 水平＞500mU/mL 的一些患者中观察到了有意义的改善，但该人群仍需要新的治疗方法。
