Increased Risk of Ischemic Stroke in Multiple Myeloma Associated With Lenalidomide Treatment: A Case Report and Review of the Literature

Abstract

Objective The aim of the study was to illustrate the increased risk of ischemic stroke in the context of multiple myeloma (MM) under treatment with lenalidomide combined with dexamethasone. Methods This is a case report and literature review. Results A 62-year-old woman diagnosed with relapsed MM under treatment with lenalidomide and dexamethasone presented with acute onset disorientation, disturbed behavior, and aphasia. Cranial computed tomography scan revealed an acute cerebral infarction in the left middle cerebral artery territory, and brain magnetic resonance imaging showed additional silent ischemic lesions in other arterial territories. Common stroke etiologies were excluded after an extensive study, leading to a final diagnosis of cerebral infarction of uncommon cause probably related to MM and treatment with lenalidomide plus dexamethasone. A literature review provided 84 reports from the license holder, 2 more cases of stroke in patients with MM receiving lenalidomide and a recurrent stroke in a patient experiencing polyneuropathy, organomegaly, endocrinopathy, monoclonal gammopathy, and skin changes (POEMS syndrome) treated with lenalidomide. Conclusions Our case exemplifies the need to raise awareness about the risk of ischemic stroke associated with MM that might be increased by treatment with lenalidomide and to establish consistent recommendations regarding thromboprophylaxis to reduce comorbidities and mortality in these patients.

Neuroinflammation as a Factor of Neurodegenerative Disease: Thalidomide Analogs as Treatments

“…Lenalidomide was determined to be safe in clinical trials for refractory melanoma, with T-cell stimulatory effects in cancer patients (Bartlett et al, 2004b). However, its association with increased risk for stroke was recently observed in multiple myeloma patients (de Celis et al, 2018). Although lenalidomide is not associated with the level of neurotoxicity that accompanies thalidomide (where peripheral neuropathy is reported in up to 83% of myeloma patients, Dalla Torre et al, 2016), with the longer use of lenalidomide reports of neurotoxicity – albeit milder than thalidomide and sometimes subclinical – are appearing in the literature (Dalla Torre et al, 2016).…”

An unorthodox presentation of multiple myeloma in the form of acute ischemic stroke, dyspnoea, thromboses in multiple arteries and abdominal pain: A case report

“…We have described an atypical presentation of multiple myeloma consisting of acute ischemic stroke, dyspnea, and moderate abdominal pain due to underlying thrombosis. Prior literature has also shown a few case reports that have described incidences of stroke in patients with multiple myeloma although most of the incidences were a consequence of chemotherapeutic drugs such as lenalidomide and carfilzomib among others [7,8]. There have been prior reports of patients with multiple myeloma having arterial as well as venous thrombotic episodes, however, they have been attributed to treatment regimens consisting of thalidomide and dexamethasone [9,10].…”

Missed diagnosis of POEMS syndrome with onset of progressive fatigue and numbness: a case report

“…Ischemic stroke has been increasingly recognized as a complication of POEMS syndrome and may be related to the vasculopathy caused by an elevated VEGF concentration. [22][23][24] Cohort studies from the Mayo Clinic and Peking Union Medical College Hospital have addressed this issue in detail. 25,26 Conversely, VEGF can promote the growth of new blood vessels and capillaries around ischemic blood vessels to improve the blood supply.…”