Lenalidomide Plus Dexamethasone is an Active Rescue Treatment for Myeloma with Severe Renal Impairment Failing to Bortezomib-Based Induction Therapy

Mele Giuseppe,Pastore Domenico

doi:10.23937/2469-5696/1410031

Abstract

Patients with relapsed/refractory Multiple Myeloma (rrMM) and End Stage Renal Disease (ESRD) requiring hemodialysis must receive lenalidomide at a dosage of 5 mg daily on days 1-21 of repeated 28-day cycles, due to substantial elimination via the kidneys. Unfortunately, despite dose reduction, severe adverse events occur with a high frequency. Therefore, lenalidomide is recommended mainly in patients with mild-to-moderate renal impairment. In our experience, different lenalidomide dose adjustment (5 mg every other day on days 1-21 of a 28-day cycle after dialysis) from the recommendations of the manufacturer was chosen due to additional fragilities (serious comorbidities, poor performance status or/and advanced age). We observed a lower-than-expected incidence of haematological toxicities without an excess of prolonged cytopenia despite long-term exposure to lenalidomide.

Highlights

The combination of “lenalidomide plus dexamethasone” is an effective option for the treatment of patients with relapsed/refractory Multiple Myeloma
There are limited experiences in patients with renal impairment who received lenalidomide because of severe adverse events that occur with a high frequency in patients with MM requiring hemodialysis treated with this drug [3,4]
De la Rubia, et al, in a multicenter retrospective study, evaluated 15 patients with relapsed MM and severe renal impairment requiring hemodialysis; grade 3/4 neutropenia was the most common side effect (53% of the patients) and severe infections were a major cause of morbidity and mortality requiring additional dose reduction of lenalidomide and G-CSF prophylaxis [3]

Summary

Introduction

The combination of “lenalidomide plus dexamethasone” is an effective option for the treatment of patients with relapsed/refractory Multiple Myeloma (rrMM). Since lenalidomide is primarily excreted unchanged by the kidney, adjustments to the starting dose are recommended to provide appropriate drug exposure in patients with moderate or severe renal impairment [1]. There are limited experiences in patients with renal impairment who received lenalidomide because of severe adverse events that occur with a high frequency in patients with MM requiring hemodialysis treated with this drug [3,4]. De la Rubia, et al, in a multicenter retrospective study, evaluated 15 patients with relapsed MM and severe renal impairment requiring hemodialysis; grade 3/4 neutropenia was the most common side effect (53% of the patients) and severe infections were a major cause of morbidity and mortality requiring additional dose reduction of lenalidomide and G-CSF prophylaxis [3]. Et al conducted a retrospective study of 26 patients of whom 6 were on dialysis; grade 3/4 thrombocytopenia was the most common side effect (66.7%) reported in patients who required dialysis [4]

Methods

Results

Conclusion