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Therapy with lenalidomide plus dexamethasone-induced bone formation in a patient with refractory multiple myeloma
Hiroyuki Tsuda1, Hiroshi Yamasaki, Takahiro Tsuji
1Department of Clinical Hematology/Oncology, Kumamoto City Hospital, Kotoh 1-1-60, Kumamoto 862-8505, Japan. tsuda.hiroyuki@cityhosp-kumamoto.jp
Abstract:
Bone disease is a major symptom of multiple myeloma, which results from excessive osteoclast activation and impaired osteoblast function. Novel antimyeloma agents, such as immunomodulatory drugs and bortezomib, alter bone metabolism in patients with this disease. However, recent studies have shown that bortezomib affects bone formation and healing, but immunomodulatory drugs do not. We report a case of refractory multiple myeloma that was treated with lenalidomide combined with dexamethasone (RD regimen). As a result, the patient's myeloma protein expression was markedly reduced, and her hematological profile was improved. However, the treatment also induced tetany by reducing her serum calcium and magnesium levels and elevating her alkaline phosphatase levels. In addition, conventional radiography and computed tomography detected osteosclerosis. These findings suggest that the RD regimen affects bone formation, possibly by activating osteoblasts. This is to our knowledge the first report to suggest that lenalidomide, an immunomodulatory drug, affects osteogenesis, at least in a certain subpopulation of patients with multiple myeloma.
Insights
Lenalidomide combined with dexamethasone (RD regimen) improved multiple myeloma but caused bone changes. This suggests lenalidomide may impact bone formation, contrary to previous beliefs about immunomodulatory drugs.
Area of Science:
- Oncology
- Bone Metabolism
- Pharmacology
Background:
- Multiple myeloma frequently causes bone disease due to osteoclast overactivity and osteoblast dysfunction.
- Novel treatments like immunomodulatory drugs and bortezomib impact bone metabolism.
- Existing research indicates bortezomib affects bone formation, while immunomodulatory drugs do not.
Observation:
- A patient with refractory multiple myeloma received the lenalidomide and dexamethasone (RD) regimen.
- The treatment improved myeloma protein levels and hematological parameters.
- However, it led to hypocalcemia, hypomagnesemia, elevated alkaline phosphatase, and osteosclerosis.
Findings:
- The RD regimen induced osteosclerosis, suggesting an effect on bone formation.
- This contrasts with the understanding that immunomodulatory drugs do not affect bone metabolism.
- The observed osteosclerosis may be due to lenalidomide activating osteoblasts.
Implications:
- This case suggests lenalidomide may influence osteogenesis in some multiple myeloma patients.
- It challenges the established view of immunomodulatory drugs' impact on bone metabolism.
- Further research is needed to understand lenalidomide's osteogenic effects in specific patient subgroups.