Lenalidomide is a second generation immunomodulatory agent (IMiD), which currently represents the standard of care for treatment of transfusion dependent lower risk myelodysplastic syndrome (MDS) patients with deletion (5q). Lenalidomide has unique activity with a high transfusion independence rate observed in this subset of patients. In this article we summarize the clinical experience using lenalidomide for treatment of del (5q) MDS. We highlight the mechanism of action and the recent advances in understanding the biology of del (5q) MDS. We also explore its potential use and the efforts to further improve its activity in non-del (5q) MDS.

Lenalidomide, myelodysplastic syndromes, deletion 5q, non-del(5q), immunomodulatory agent (IMiD), bone marrow failure, anemia, cytokines, apoptosis, myeloblast

H Lee Moffitt Cancer Center and Research Institute, FOB-3rd Floor, 12902 Magnolia Drive, Tampa, Florida 33612, USA.