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A 78-year-old female presents for further evaluation of anemia. Physical examination reveals no lymphadenopathy or organomegaly. Laboratory evaluation shows hemo-globin of 8.2 g/dl. mean corpuscular volume of 1 06 fl. leukocyte count of 6.700/f.l.l. and platelet count of 5 62 .000/ f.l.l. Peripheral smear is shown below.
Bone marrow aspiration and biopsy were obtained and revealed hypercellulari ty and no increased ri ng sideroblasts. Bone marrow aspirate is shown below.
What is the most appropriate management of this patient?
- Reduced intensity allogeneic hematopoietic stem cell transplantation
- Hypomethylating agent (azacitidine or decitabine)
- Cytarabine and daunorubicin (7 + 3 regimen)
- Observation
- Lenalidomide
Medicine
E. Lenalidomide has shown remarkable activity in MDS with Sq- syndrome. Several studies documented transfusion independence and cytogenetic responses rate of 67% and 77%, respectively.
Studies have linked deletions in 5q to decreased expression of the ribosomal gene RPS 14, whose prod-uct is required for the maturation of 40S ribosomal subunit. Additional studies have implicated de-creased levels of micro-RNAs, miR-145 and miR-146a, that are encoded in proximity to RPS14 gene, in cases of 5q- syndrome (Blood. 2009; 113(17):3947, Br l Haematol. 2008;140(3):267, NE]M. 2006;355(14):1456, Blood. 201 1; 1 18(14):3765, Nature. 2008;45 1(7176):335, Br J Haematol. 2008; 142(1)57, Br l Haematol. 2007;139(4):578, Nat Med. 2010;16(1):49).
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