I. Indications.
Transfusion-dependent low- or intermediate-risk MDS with chromosome 5q-abnormalities in anemic patients
II. Contraindications.
1. patients with hypersensitivity to lenalidomide
2. Patients who are pregnant
3. Patients who are breastfeeding
4. neutrophils <0.5G/L
5. platelets <30G/L
III. Examination items.
1. bone marrow aspiration
2. chromosome examination
3. blood count, liver and kidney function
4. pregnancy-related tests
5. TSH (thyroid function test)
6. Weekly blood tests, liver and kidney function tests for the first month
7. monthly blood tests, liver and kidney function tests afterwards
8. TSH check once every three months
9. Regular pregnancy tests
10. Pay attention to the analysis and management of rash, diarrhea, fatigue and respiratory symptoms
IV. Preventive medication.
1. For patients with a history of thrombosis, apply low molecular heparin when platelets are >50G/L
V. Medications.
Lenalidomide
VI. Dosage.
10mg orally once daily for 21 days, repeated once in 28 days
VII. Discontinuation.
No efficacy response for 4 courses of treatment
VIII. Adjustment of dosing.
After 4 weeks Platelets between 30-50 5mg/day
After 4 weeks Neutrophils at <0.5 5mg/day
1. creatinine clearance >= 50 (mL/min), lenalidomide dose: 10mg/day
2. creatinine clearance 30-49 <50 (mL/min), lenalidomide dose: 5mg/day
3. creatinine clearance <30(mL/min) without dialysis, lenalidomide dose: 5mg/day every other day
4. Creatinine clearance <30 (mL/min), dialysis required, lenalidomide dose: 5mg/day three times a week Post-dialysis administration
IX. Precautions.
1. neutropenia: must be detected as soon as possible, treatment measures in place
2. thrombocytopenia: platelet transfusion if necessary
3. thrombosis
4. allergic reactions
5. cardiotoxicity