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

Riad Elfakih,Ghada Elgohary,Mohammad Al Nahedh,Angela Pia Cazzolla

doi:10.14302/issn.2641-5518.jcci-19-2664

Abstract

Lenalidomide is a second generation immunomodulatory agent and a potent analogue of thalidomide that is FDA approved mainly for the treatment of multiple myeloma (MM) and transfusion-dependent anemia due to low or intermediate-1- risk myelodysplastic syndromes (MDS) associated with 5q deletion among other indications. Through its action on the immune system, lenalidomide alters the production of different cytokines ultimately resulting in immune activation against tumors. This immune activation may lead to collateral immune toxicities like fever, angioedema, Stevens-Johnson syndrome, tumor flare and others. Here we report a case of lenalidomide-induced high grade fever in a patient with MM and we summarize the literature about the physiology of such reaction and how to mitigate this adverse event.

Highlights

Corresponding author: Ghada ElGohary, Department of Adult Hematology/Oncology, King Khaled University Hospitals, College Of Medicine, King Saud University, Riyadh, Saudi Arabia, & Department of Adult Hematology/ Internal Medicine, Ain Shams University Hospitals, College Of Medicine, Cairo, Clininic Adult Hematology / Stem cell Transplant,Ain Shams Universiry /Cairo/Egypt
A 59 year-old-woman with newly diagnosed IgG kappa MM presented to the emergency department with fever and generalized body aches one day after starting her first cycle of therapy with lenalidomide, bortezomib and dexamethasone
Patient was treated with low dose lenalidomide (10 mg daily), bortezomib and dexamethasone and tolerated this regimen well and later on lenalidomide dose was escalated to the standard dose of 25 mg daily

Summary

Case Report

A 59 year-old-woman with newly diagnosed IgG kappa MM presented to the emergency department with fever and generalized body aches one day after starting her first cycle of therapy with lenalidomide, bortezomib and dexamethasone. She denied any shortness of breath, cough, runny nose, dysuria, diarrhea, abdominal pain, and headache or neck stiffness. Infectious workup included repeated blood and urine cultures, chest x-ray, nasal swab for viruses and all were negative. Her complete blood count and differential was within normal limits. Patient was treated with low dose lenalidomide (10 mg daily), bortezomib and dexamethasone and tolerated this regimen well and later on lenalidomide dose was escalated to the standard dose of 25 mg daily

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Discussion

Conclusion