Lenalidomide Plus Decitabine Treatment in a Myelodysplastic Syndrome Patient With Deletion 5q and Excess Blasts

This is the first case of decitabine plus lenalidomide treatment for a myelodysplastic syndrome (MDS) patient with 5q deletion (del(5q)) and elevated number of blasts. Upon bone marrow aspiration and biopsy with conventional cytogenetical studies she was diagnosed with MDS with del(5q) and refractory anemia with excess blasts (RAEB-1). Decitabine was started at a daily dose of 20 mg/m2 1 - 5 days and lenalidomide was started at daily doses of 10 mg 6 - 20 days a month. After two cycles, her hemoglobin level increased and transfusion dependency ceased. After four cycles, bone marrow aspiration showed blast ratio of < 5%. Decitabine and lenalidomide were applied for three more cycles. Decitabine was terminated after seven cycles and lenalidomide has been continued for 12 months. Latest blood values (February 2020) were as follows: white blood cells (WBCs) of 8,670/mm3, neutrophil count of 3,470/mm3, hemoglobin (Hb) level of 11.7 g/dL and platelet count of 203,000/mm3, and the patient continues to follow-up without treatment. In conclusion, combination of lenalidomide and decitabine seems to be an effective treatment modality without notable side effects in MDS patients with del(5q) and excess blasts. The efficacy of this combination should be validated with studies including large patient groups and with longer follow-up periods.