Madness Of PDK4

41 In this study, 214 patients received lenalidomide at a dose of 10 mg daily or 10 mg on days 1�C21 of a 28 day cycle. Twenty-six percent of patients achieved transfusion independence. Grade 3 or 4 neutropenia was observed in 30% of patients, and grade 3 or 4 thrombocytopenia was seen in 25% of patients. In a retrospective study that utilized data gathered from two Phase II trials described above,38,41 Sekeres et al investigated the relationship of treatment-related cytopenias and response to lenalidomide in patients with lower-risk MDS.42 In these studies, MDS patients with the 5q deletion developed treatment-related thrombocytopenia at higher rates than patients Pifithrin-�� mouse without the 5q abnormality. Among patients with the 5q deletion, 70% percent of patients whose platelet count decreased by 50% or more experienced transfusion independence, compared to transfusion independence in only 42% in patients whose platelet counts decreased by less than 50%. Moreover, among patients with the 5q deletion who did not have baseline neutropenia, PDK4 82% of those whose absolute neutrophil count decreased by 75% or more achieved transfusion independence, compared with 51% of those whose absolute neutrophil count remained stable. The authors conclude that their results corroborate a direct cytotoxic effect specific to the clone possessing the 5q deletion. Lenalidomide is not currently approved for IPSS intermediate-2- or high-risk MDS but has been used in this setting. In a Phase II trial, 47 patients with higher-risk MDS harboring the 5q deletion received lenalidomide at a dose of 10 mg daily. Twenty-seven percent of patients achieved a hematologic response, including seven patients who achieved morphologic complete remission (CR). Interestingly, 35% of patients with initial platelet counts greater than 100,000/mm3 achieved CR, compared to none of the patients with platelet counts lower than 100,000/mm3. AML Lenalidomide is not approved for use in AML but has been used increasingly in the setting of relapsed/refractory AML and in older patients with AML. One report describes sustained morphologic and cytogenetic CR in two AML patients, ages 71 and 68 years, treated RGFP966 solubility dmso with high-dose single-agent lenalidomide.43 Each patient had trisomy 13 as their sole cytogenetic abnormality. Moreover, high-dose lenalidomide has been examined in a Phase II study of patients 60 years of age or older.44 Patients received up to two 28-day cycles of lenalidomide at a dose of 50 mg daily followed by low-dose maintenance (10 mg daily). Thirty percent of patients achieved CR or CR with incomplete recovery of blood counts (CRi). CR/CRi was seen only in patients who had white blood cell counts