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MDS del(5q) — RACP Adult Medicine MCQ

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HardHaematologyMDS del(5q)RACP Adult Medicine

A 68-year-old woman with myelodysplastic syndrome (MDS) and del(5q) has symptomatic anaemia requiring regular transfusions. Her blasts are <5%. She has failed erythropoiesis-stimulating agents. What is the most appropriate therapy?

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Correct answer: B — Lenalidomide

Lenalidomide is specifically effective for MDS with isolated del(5q), producing transfusion independence in ~67% of patients (MDS-003 and MDS-004 trials). It works by targeting the CK1α pathway. Response is monitored with regular CBC. Lenalidomide is PBS-listed in Australia for this indication. Luspatercept is an alternative for lower-risk MDS with ring sideroblasts. Azacitidine is used for higher-risk MDS.

Reference: eTG – 2025 – Haematology; NCCN – 2025 – MDS Guidelines