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Management of Cytopenias During Treatment with Lenalidomide in Patients with Myelodysplastic Syndromes

Lenalidomide is approved for the treatment of Low and Intermediate-1 risk International Prognostic Scoring System categorized myelodysplastic syndromes (MDS) with deletion (del (5q)), and has an evolving role in other subtypes of MDS. Severe cytopenias may emerge with lenalidomide treatment, which appear to be related to elimination of the dysplastic clone. Although guidelines based on expert opinion have been published, the optimum management of lenalidomide-induced cytopenias in MDS in the "real world" setting is still evolving. We report two illustrative cases of lenalidomide-induced cytopenias in patients with del (5q) MDS, present an updated review of the literature and provide practical guidance for the management of cytopenias during lenalidomide treatment of MDS.