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Anemia is a principal feature of the myelodysplastic syndrome with deletion of chromosome 5q; most patients require transfusions, and iron overload develops as a consequence. In this phase 2 trial, lenalidomide reduced dependence on transfusions in most patients, and two thirds of them could stop transfusions altogether. The drug, an analogue of thalidomide, also reversed chromosomal and cytologic abnormalities in many patients. Lenalidomide reduced dependence on transfusions in most patients with the myelodysplastic syndrome, and two thirds of them could stop transfusions altogether. The drug also reversed chromosomal and cytologic abnormalities in many patients. Interstitial deletions involving the long arm of chromosome 5 are among the most common cytogenetic abnormalities identified in patients with the myelodysplastic syndrome, with frequencies ranging from 16 to 28%. 1 , 2 Although the size of the interstitial deletions varies, deletion mapping has shown that the common deleted region involves a 1.5-Mb segment extending from bands 5q31 to 5q32. 3 A tumor-suppressor gene is postulated to reside in this region, but no specific gene with pathogenetic relevance has been identified. Patients with the 5q deletion have distinct clinical and pathological features that include a hypoproliferative anemia and dysplastic megakaryocytes in the bone . . .