Tweets by scisetglobal

A Case Report: Lenalidomide-Associated High-Grade Fever in a Multiple Myeloma Patient

Department of Pharmacy, The First Affiliated  Hospital of College of Medicine, Zhejiang  University, Hangzhou, Zhejiang, P.R. China

Keywords

Lenalidomide; Fever; Toxicity

Abstract

Lenalidomide, a second-generation immunomodulatory agent and potent analogue  of thalidomide, is primarily FDA-approved for treating multiple myeloma (MM)  and transfusion-dependent anemia associated with low or intermediate-1-risk  myelodysplastic syndromes (MDS) linked to 5q deletion, among other indications.  By modulating the immune system, lenalidomide influences cytokine production,  ultimately activating immune responses against tumors. However, this immune  activation can result in collateral immune toxicities such as fever, angioedema,  Stevens-Johnson syndrome, tumor flare, and others. We present a case of highgrade fever induced by lenalidomide in a patient with MM and provide a literature  review on the underlying physiology of this reaction and strategies for managing  this adverse event.

Lenalidomide, a second-generation immunomodulatory agent and potent analogue  of thalidomide, is primarily FDA-approved for treating multiple myeloma (MM)  and transfusion-dependent anemia associated with low or intermediate-1-risk  myelodysplastic syndromes (MDS) linked to 5q deletion, among other indications.  By modulating the immune system, lenalidomide influences cytokine production,  ultimately activating immune responses against tumors. However, this immune  activation can result in collateral immune toxicities such as fever, angioedema,  Stevens-Johnson syndrome, tumor flare, and others. We present a case of highgrade fever induced by lenalidomide in a patient with MM and provide a literature  review on the underlying physiology of this reaction and strategies for managing  this adverse event.

1. Kotla V, Goel S, Nischal S, Heuck C, Vivek K et al. (2009) Mechanism  of action of lenalidomide in hematological malignancies. , Journal of  hematology & oncology 2(1), 36. 

2. Chanan-Khan A A, Cheson B D. (2008) Lenalidomide for the treatment of B-cell malignancies. , Journal of Clinical Oncology 26(9),  1544-1552.

3. BYH Thong, Tan T C.Epidemiology and risk factors for drug allergy. ,  British journal of clinical 71(5), 684-700. 

4. Riedl M A, Casillas A M. (2003) Adverse drug reactions: types and  treatment options. , American family physician 68(9), 1781-1790. 

5. Ferrajoli A, Lee B-N, Schlette E J, O'Brien S M, Gao H et al.  (2008) Lenalidomide induces complete and partial remissions in patients with relapsed and refractory chronic lymphocytic leukemia. ,  Blood 111(11), 5291-5297. 

6. Quach H, Ritchie D, Stewart A K, Neeson P, Harrison S et al.Mechanism  of action of immunomodulatory drugs (IMiDS) in multiple myeloma.  24(1), 22