Craddock C, et al. - Researchers examined the combination of lenalidomide (LEN) and azacitidine (AZA) for tolerability and activity in relapse after allogeneic stem-cell transplantation (allo-SCT). Twenty-nine patients who had relapsed after allo-SCT for acute myeloid leukemia (AML) (n = 24) or myelodysplasia (MDS) (n = 5) were treated with sequential AZA (75 mg/m2 for 7 days) followed by escalating doses of LEN on days 10 to 30. The patients tolerated this sequential therapy well. The maximum tolerated dose of post-transplantation LEN in combination with AZA was determined to be 25 mg daily. Outcomes suggest administration of LEN in conjunction with AZA post-allograft was safe. In relapsed AML/MDS, this combination demonstrated clinical activity without reversing biologic features of T-cell exhaustion. For patients who had relapsed post-allograft, combined LEN/AZA therapy represents a novel and active salvage therapy.