Q: My 60 years old father is suffering from MDS (Myelodysplastic syndrome) (RA) for the past one year. He started treatment with Thalidomide (100 mg). After that, Hb rose to 11.5 g/dl and platelet counts went up to 100,000/mcl. But for the past two months, my father’s Hb has come down to 7.9 g/dl and platelet counts have dipped to 10000/mcl. Now, the doctor has started Lenalidomide (5 mg) but there is no sign of improvement despite taking the drug for the last six months. Is my father undergoing the right treatment?

A:Myelodysplastic syndrome can progress to Acute Leukemia. Your father had good response with Thalidomide and now relapsed and not responding to lenalidomide. Low Hb and Low platelet could be secondary to Lenalidomide or disease progression. He needs a repeat bone marrow with cytogenetics study on marrow sample before we decide about the therapy. The options will be according to bone marrow morphology. Meanwhile one may consider starting injection Erythropoietin 40,000 U subcutaneously once a week.