Efficacy And Adverse Events Of Lenalidomide For Myelodysplastic Syndromes:A Systematic Review

Objective: To assess clinical efficacy and adverse events of lenalidomide in the treatment of myelodysplastic syndromes(MDS).Methods: Searched the databases such as PubMed, EMbase, The Cochrane Library, WANFANG, CNKI and CBM(from inception to Jan, 2016).The quality of the included studies was assessed, and the data was extracted.Meta-analysis was performed by RevMan 5.3 and R-Project software 3.2.3.The incorporated odds ratio(OR) and 95% confidence interval(CI) of the included studies were calculated, respectively.Results: Five clinical trails were finally included.It was showed that the RBC-transfusion independence(TI) for≥26 weeks rate of del5 q MDS patients with intermediate-1 or low IPSS risk was improved in lenalidomide 10 mg group compared with the control group by meta-analysis [OR=30.97, 95%CI(10.31, 93.01), P<0.00001], similarly in lenalidomide 5mg group[OR=15.70, 95%CI(5.25, 46.98), P<0.00001].Besides, compared with the 5mg group, the RBC-transfusion independence(TI) for≥26 weeks rate [OR=1.98, 95%CI(1.09, 3.6), P=0.02] was improved in the 10 mg group. Data showed that the erythroid response rate was 67%[95%CI(0.55, 0.77)], the cytogenetic response rate was 50%[95%CI(0.40, 0.61)], the acute myeloid leukemia(AML) progression rate was 13%[95%CI(0.08, 0.21)], the grade Ⅲ/ Ⅳneutropenia rate was 78%[95%CI(0.61, 0.88)], the grade Ⅲ/ thrombocytopenia rate Ⅳ was 39%[95%CI(0.27, 0.51)], the grade Ⅲ/ Ⅳdeep-vein thrombosis(DVT) rate was 4%[95%CI(0.03, 0.08)]. For higher risk(intermediate-2 or high) or non-del5 q MDS patients, since lack of clinical trails, descriptive analysis was made in this study.Conclusion: When lenalidomide was administered to patients with MDS, RBC-transfusion independence(TI) for≥26 weeks rate, erythroid response rate, and cytogenetic response rate were significantly improved, and the time of transformation to AML was prolonged. Yet the main adverse event was myelosuppression. Using lenalidomide in higher risk or non-del5 q MDS, response rates were well and adverse events were rare.