Objective: Myelodysplastic syndromes (MDS) is a very heterogeneous disorder and high risk of transformation to acute leukemia. Diagnosis of MDS is based on cytopenia, morphological evidence of dysplasia and bone marrow cytogenetic analysis. Treatment options were depended on prognostic risk, transfusion needs, and percent of blasts, cytogenetic and mutational profiles, and comorbidities. The prognosis of higher risk MDS patients are poor and the goal of therapy is to prolong survival. Lenalidomide can decrease transfusion requirements and improve cytogenetic and cytologic abnormalities in MDS patients with the deletion 5q. However, lenalidomide is not currently used for patients with deletion 5q and bone marrow blasts more than 5%. Method: The present study we report an older MDS patient with deletion 5q and excess blasts (9%) who was treated with decitabine combined with HAG regimen, after one cycle, the bone marrow blasts decreased to 5.5%, then lenalidomide monotherapy was administered to maintenance therapy due to the patient refused to continue chemotherapy. Result: Patients adhere to regular outpatient follow-up; the patient's blood cell counts were basically normal and no drug-related adverse reactions occurred. By the follow-up date of June 30, 2021, the patient had been disease-free survival for 2 years. Conclusion: lenalidomide alone therapy followed by decitabine combined with HAG regimen may be an effective treatment in elderly MDS patients with 5q deletion and excess blasts who cannot tolerate chemotherapy. Further studies and larger sample groups are needed to validate the effectiveness of this treatment option.
Keywords: Lenalidomide; Myelodysplastic syndromes; Excess blasts type 1; Deletion 5q; ETNK1 mutation