For patients randomized to lenalidomide 10 mg, one of eight (12.5%) p53-positive patients had a cytogenetic response compared to 16 of 19 (84.2%) p53-negative patients….In conclusion, we found that strong p53 protein expression by IHC is the strongest independent predictor of AML transformation, and also an independent predictor of overall survival and lower cytogenetic response in lower-risk del(5q) MDS patients treated with lenalidomide.