Lenalidomide (Revlimid) is the preferred first-line treatment for lower-risk myelodysplastic syndrome (MDS) with a 5q chromosome deletion. In clinical trials, lenalidomide reduced the need for frequent blood transfusions and many patients achieved remission. But clinical trial settings don’t always reflect what happens in everyday medical care.
A recent real-world study showed that the Affordable Care Act (ACA) improved patient access to lenalidomide, nearly tripling its use in everyday clinical settings. The research also highlighted remaining disparities. Prescription access still depends on a patient’s insurance type, with less access for those onMedicaid compared to Medicare.
How policy, insurance, and health factors shape MDS care
To evaluate how lenalidomide is used in the real world, researchers analyzed data from the National Cancer Database. The data covered 3,328 adults diagnosed with MDS with 5q deletion between 2006 and 2021. The average patient age in the group was 77 years, and 56% were women. The study aimed to track how often patients received lenalidomide and what health or socioeconomic factors influenced overall survival.
How patient access to lenalidomide changed after the ACA
Surge in lenalidomide treatment rates: Before the ACA was enacted, only 12% of patients with MDS with 5q deletion received lenalidomide. After the ACA took effect, utilization rose to 32%.
Impact of insurance type on lenalidomide treatment: Patients with Medicaid were significantly less likely to receive lenalidomide compared to patients enrolled in Medicare.
Overall lenalidomide utilization: Across the entire 15-year study period, only 21% of all eligible patients with MDS with 5q deletion in the database received lenalidomide.
Baseline health can impact patient outcomes
In this real-world registry analysis, the overall median survival for patients was 15.7 months. When examining factors that influenced survival length, researchers found that overall health outcomes were primarily driven by a patient's age and baseline health conditions rather than whether they received lenalidomide alone:
People over 80 years old or those with more pre-existing health conditions (comorbidities) were associated with shorter overall survival.
Female patients had an improved overall survival compared to male patients.
Researchers emphasized that while registry databases provide a vital window into real-world care, they also have limitations. More studies are needed to understand individual prescribing decisions and ensure that every patient receives optimal treatment regardless of their insurance plan.
Explore more articles and resources and make informed decisions with your health team
If you or a loved one are navigating a diagnosis of MDS with 5q deletion, and feel curious if this treatment is an option for you, we encourage you to talk with your lenalidomide directly with your hematologist. Ask whether it is appropriate for your specific MDS subgroup and how it fits into your treatment plan.
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