Lenalidomide induced intrahepatic cholestasis in newly diagnosed patients of multiple myeloma

Abstract

The chemotherapeutic regimen melphalan, prednisolone, and thalidomide (MPT) is the standard of care for symptomatic multiple myeloma patients who are not eligible for high dose chemotherapy followed by autologous stem cell therapy. Lenalidomide, a newer thalidomide derivative, is 300 times more potent than thalidomide. Combined therapy using melphalan, prednisolone, and lenalidomide (MPL) is very effective with many advantages. We report here one rare adverse effect, i.e., intrahepatic cholestasis related to lenalidomide, in two patients out of a total of 65 newly diagnosed cases of multiple myeloma receiving MPL regimen in our series. As the use of lenalidomide will increase in the future for multiple myeloma and other diseases, clinicians should be aware of this entity.

The use of Novel Agents in Multiple Myeloma Patients with Hepatic Impairment

“…No hepatic grade 3 or 4 adverse events (AEs) were reported in the MM-009 and MM-010 trials, which led to approval of lenalidomide in the relapsed/refractory MM population [27,28]. To our knowledge, five case reports of lenalidomide-induced hepatocellular and/or cholestatic injury have been reported in patients with MM (Table 2) [32–35]. All of the patients were male and three had renal insufficiency.…”

Severe Lenalidomide-Associated Hyperbilirubinemia

“…There have been reported cases of lenalidomide-induced intrahepatic cholestasis with direct hyperbilirubinemia, with bilirubin levels that follow a similar laboratory trend to our patient’s levels. However, these cases did not cause extreme hyperbilirubinemia and had significant elevations of alkaline phosphatase [ 12 ], which was not seen in our patient.…”