Lenalidomide in myelodysplastic syndromes: where do we go from here?

Myelodysplastic syndromes (MDS), or myelodysplasia, are a heterogeneous group of bone marrow disorders characterized by progressive cytopenias and a propensity to evolve into acute leukemia. The only curative strategy in the treatment of MDS is stem cell transplantation. The advent of hypomethylating agents and, more recently, lenalidomide has changed the paradigm so that supportive treatment for patients who are not candidates for transplantation now includes drugs that may alter the natural history of the disease. The remarkable results observed with lenalidomide in patients with del(5q) has promoted intense research into the pathobiology of MDS and new approaches to treatment; it is hoped that this success will be extended to all subtypes of patients with MDS.