case_images: PMC4036206_01
case_images: Sequential bone marrow karyotype and FISH studies: percentage of del(5q) and Y chromosome loss from October 2007 to March 2014 during the various phases of lenalidomide treatment.
case_images: cro-0007-0277-g01.jpg
case_images: PMC4036206_01_cro-0007-0277-g01.jpg
case_images: F1
case_images: Then we treated him with 5 mg biweekly for 3 weeks of every 28-day cycle for 12 cycles, remaining transfusion independent and in complete hematological and cytogenetic remission (fig. 1; table 1), with a range of platelet count between 149 and 128 x 109/l. After 1 year of this schedule, the patient had a cytogenetic relapse with 2/10 metaphases and 18% interphase nuclei showing a 5q- (fig. 1), but he remained transfusion independent (Hb 13.9 g/dl, MCV 100 fl, platelet count 128 x 109/l, WBC 3.5 x 109/l, ANC 1.09 x 109/l and vitamin B12 831 pg/ml). However, we decided to stop lenalidomide treatment and observed him for 14 months; at this time, 5q- was detected in 8/10 metaphases and in 60% of the interphase nuclei (Hb 12.1 g/dl, MCV 108 fl, vitamin B12 792 pg/ml, platelet count 182 x 109/l); the patient was rechallenged with lenalidomide 10 mg for 21 days every 4 weeks (fig. 1). We reduced the dose at 10 mg biweekly for 3 weeks every 28 days for 4 months; then 5q- was detected in 44% interphase nuclei (fig. 1), karyotype was not available, Hb was 13.5 g/dl, MCV 100 fl and vitamin B12 280 pg/ml. Hb was 13.9 g/dl, MCV 96 fl, vitamin B12 1,344 pg/ml, bone marrow blasts 3%, and a partial cytogenetic remission was obtained (fig. 1). Here we increased lenalidomide to 10 mg for 21 days every 4 weeks (6 cycles). After these 6 cycles, 1/10 metaphases and 4% of interphase nuclei showed 5q-, no bone marrow blasts were observed, but the development of a new independent clone was detected by cytogenetic and FISH analyses, containing loss of the Y chromosome in 2/10 metaphases and in 28% of interphase nuclei (fig. 1).
case_images: Changes in Hb levels from October 2007 to March 2014 under various phases of lenalidomide treatment.
case_images: cro-0007-0277-g02.jpg
case_images: PMC4036206_01_cro-0007-0277-g02.jpg
case_images: F2
case_images: He responded to the reintroduction of lenalidomide, achieving complete cytogenetic remission after 3 cycles and continuing lenalidomide at a standard dose of 10 mg until the sixth course [Hb was 14 g/dl (fig. 2), MCV decreased to 99 fl and vitamin B12 decreased to 442 pg/ml, platelet count 122 x 109/l, WBC 3.03 x 109/l, and ANC 2.2 x 109/l].