Chemotherapy: lenalidomide in del(5q) MDS: practice question

A Pharmacology question in the style of the NEET PG paper. Answer it first, then read why the right option is right and why each of the others is wrong.

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Pharmacology · Chemotherapy: lenalidomide in del(5q) MDS

Sample item

A 72-year-old woman has transfusion-dependent macrocytic anaemia. Marrow shows myelodysplasia with an isolated deletion of chromosome 5q, and erythropoietin has failed. Which oral drug is most likely to produce transfusion independence?

Original practice item, not a recalled exam question. Nothing here is recorded.

The answer and the reasoning

D. Lenalidomide

Lenalidomide, a thalidomide analogue with immunomodulatory activity, induces erythroid response in most patients with del(5q) myelodysplastic syndrome. Its main toxicities are neutropenia, thrombocytopenia and venous thromboembolism, and it is teratogenic like thalidomide.

Option by option

  • A. Imatinib

    Imatinib targets BCR-ABL and related kinases and does not treat del(5q) MDS.

  • B. Rituximab

    Rituximab is an anti-CD20 antibody for B-cell malignancies and has no role here.

  • C. All-trans retinoic acid

    All-trans retinoic acid induces differentiation in acute promyelocytic leukaemia.

  • D. Lenalidomide (correct)

    Correct. Lenalidomide produces transfusion independence in del(5q) myelodysplastic syndrome.

Source note: Original NextPrep sample item — pending expert review. This item is original practice material awaiting independent expert review, so confirm important facts in a standard textbook.

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Questions about this Pharmacology question

What is the answer to this Pharmacology question?

The best answer is D, Lenalidomide. Lenalidomide, a thalidomide analogue with immunomodulatory activity, induces erythroid response in most patients with del(5q) myelodysplastic syndrome.

Why is "Imatinib" not the answer?

Imatinib targets BCR-ABL and related kinases and does not treat del(5q) MDS.

Why is "Rituximab" not the answer?

Rituximab is an anti-CD20 antibody for B-cell malignancies and has no role here.

Why is "All-trans retinoic acid" not the answer?

All-trans retinoic acid induces differentiation in acute promyelocytic leukaemia.

What concept does this question test?

It tests Chemotherapy: lenalidomide in del(5q) MDS in Pharmacology. Its main toxicities are neutropenia, thrombocytopenia and venous thromboembolism, and it is teratogenic like thalidomide.

How hard is this question?

We tag it as an application question: it asks you to use a fact on a patient or a finding. The tag is our own editorial judgement, not an official difficulty rating, so read the reason for every option, not only the answer.

How should I study Chemotherapy: lenalidomide in del(5q) MDS?

Learn drugs as classes, then the exception in each class that an examiner would pick. Then use the flashcards and the other Pharmacology questions on this site to test what stuck.

Is this a real NEET PG question?

No. It is an original practice item (editorial status: sample, version 1). NextPrep does not publish recalled or leaked questions, and independent faculty review of this item has not been completed yet, so confirm important facts in a standard textbook.