Guilt by Association

groups, although crossover from placebo to lenalidomide confounded the ability to assess the effect of the drug on this or on leukemia transformation. Erythroid and cytogenetic responses appeared lower than those seen in the MDS-003 trial despite similar baseline characteristics, as might be expected when moving from the phase 2 to the phase 3 setting, but are still substantial8 (see table). So, is this fourth study of lenalidomide in MDS truly “the charm?” To answer, we turn to the etymology of the phrase, “Third time’s the charm.” A popular interpretation from the 19th century refers to an English law freeing a condemned man after 3 failed attempts at hanging him. Yet, the approximate phrase appears earlier, in Shakespeare’s The Merry Wives of Windsor, as stated by the character Falstaff: “Pr’ythee, no more prattling— go. I will hold: this is the third time; I hope good luck lies in odd numbers.... They say there is divinity in odd numbers, either in nativity, chance, or death” (Act V, scene 1, lines 1-5). Perhaps for lenalidomide, and more importantly for MDS patients, there is good luck in even numbers, with excellent response rates and hopefully, less chance of death by disease or leukemia, although this remains to be seen. Conflict-of-interest disclosure: The author has served on an advisory board for Celgene. ■