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A combination therapy of **lenalidomide**, an immunomodulatory small molecule and thalidomide analogue, and **recombinant human erythropoietin (epoetin alfa or beta)**, a biologic erythropoiesis-stimulating agent (ESA), used primarily in lower-risk, non-del(5q) myelodysplastic syndrome (MDS) patients with anemia resistant to ESAs. Lenalidomide modulates the immune system, inhibits angiogenesis, and promotes malignant cell apoptosis, while also augmenting erythropoietin receptor signaling. Recombinant human erythropoietin directly stimulates erythropoiesis by binding and activating the erythropoietin receptor. The combination results in superior **erythroid response rates** and durability compared to lenalidomide monotherapy in this population[1][2][3][4][6].
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