11198 Background: Lenalidomide is the preferred first-line agent for lower risk MDS w 5q. It is associated with higher rates of transfusion independence and cytogenetic remission and has demonstrated survival benefit in selected clinical trial populations. Large nationwide studies are lacking in this subgroup. Methods: We identified adults aged > 18 years with MDS w 5q diagnosed between 2006 and 2021 using the National Cancer Database (NCDB), corresponding to Lenalidomide approval. Demographic, socioeconomic characteristics, insurance status, Charlson-Deyo comorbidity index (CCI), and treatment variables were extracted. The primary outcome was receipt of lenalidomide therapy. Secondary outcomes included overall survival (OS). Patients were categorized into pre-Affordable Care Act (ACA) and post ACA periods. Multivariable logistic regression and relative risk models were used. OS was estimated using Kaplan-Meier methods and differences between groups were compared with log-rank tests. Multivariable Cox proportional hazards model was used to assess factors associated with survival. P 80 (HR 1.0; ref = 61-70), receipt of chemotherapy (HR 1.35) and increasing commodity burden [CDS: HR 1.27; CDS:2 HR 1.45, CDS 3: HR 1.95; all p < 0.001). Female sex was associated with improved survival(HR 0.76; p < 0.001). Lenalidomide receipt was not independently associated with OS after adjustment (HR 1.05; p = 0.27). Conclusions: This is the largest study evaluating receipt of lenalidomide in MDS with 5q deletion. Lenalidomide utilization increased substantially following ACA implementation, leading to improved access to disease modifying therapy. However, Medicaid insurance was associated with lower treatment receipts. Survival outcomes were primarily driven by age, commodity burden and treatment intensity rather than Lenalidomide receipt, highlighting persistent disparities and limitations of registry-based analysis.
Sajeev et al. (Wed,) studied this question.