About treatment with Revlimid (lenalidomide) and EPO

[Birgitta-A]

Hi all,
Here is a thesis about anemia in MDS patients. There is interesting info about Revlimid and up-regulation of a tumor suppressor gene:
http://diss.kib.ki.se/2008/978-91-7409-100-7/
Kind regards
Birgitta-A

[Neil Cuadra]

I didn't know the term "up-regulation" so I had to look it up.

It means that a cell responds to an external factor, like a drug, by increasing the amount of a protein, enzyme, or other component of the cell. Sometimes that's the desired effect of a drug, while in other cases down-regulation (a decrease) is the desired effect.

If I understand the report correctly, it concludes that lenalidomide (Revlimid) up-regulates the gene called SPARC, which suppresses tumors. This gene normally resides at the 5q location that is missing in 5q- syndrome.

[Birgitta-A]

Hi Neil,
Yes, and the important issues in Jäderlunds thesis is that the researchers are trying to make a pre-treatment risk-stratification.

We already know much about which patients that will respond to EPO like Aranesp and drugs like Neupogen (these findings are not new):
1 Patients with a transfusion need less than 2 units of packed red blood cells a month.
2 Patients with a Serum-EPO less than 500 U/l
A patient that have both these variables will respond in 74 % of the cases, a patient with one of these variables in 23 % of the cases and patients without these variables in 7 % of the cases.

Then we hope that the researchers will be able to assess the expression of individual genes especially the SPARC gene expression in all patients. If the SPARC expression levels are increased by Revlimid the patients will respond to the treatment.
Kind regards
Birgitta-A