, Volume 89, Issue 4, pp 425-426
Date: 25 Aug 2009

Treatment of 5q-syndrome with lenalidomide in an HIV-positive patient under cART

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Dear Editor,

Lenalidomide has emerged as standard treatment for 5q-syndrome [1]. In normal cell cultures, lenalidomide enhances T cell proliferation [2], and in cells isolated from HIV-positive (HIV+) and CMV+ patients, lenalidomide enhances CD8+ cytotoxic T cell activity against viral antigens [3]. There are no in vivo data on lenalidomide in HIV+ patients.

We are reporting on a 52-year-old HIV+ patient with an undetectable viral load for the past 10 years on combined antiretroviral therapy (cART) who developed 5q-syndrome and was successfully treated with lenalidomide. In 1989, he was diagnosed with HIV and had been on cART since 1996 after mono- and bi-therapies. He had suffered and recovered from multiple complications (CMV-retinitis, Kaposi sarcoma, cryptococcal meningitis, oesophageal candidiasis, disseminated Mycobacterium genavense infection and anal squamous cell carcinoma (T1N0M0)). In February 2007, persistent pancytopenia and dependency on red blood cell transfusions for a mo