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Lenalidomide Desensitization in Systemic Light-Chain Amyloidosis With Multi-Organ Involvement
Jack T Seki1, Naoko Sakurai2, Vishal Kukreti3
1Department of Pharmacy, Princess Margaret Hospital, Toronto, ON, Canada ; Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, ON, Canada ; College of Pharmacy and Health Sciences, Drake University, Des Moines, IA, USA.
Journal of Clinical Medicine Research
|September 9, 2015
Summary
Systemic amyloidosis (AL) patients with multi-organ impairments can now benefit from lenalidomide rapid desensitization. This approach successfully managed severe skin toxicity, enabling treatment in a previously ineligible patient.
Area of Science:
- Hematology
- Oncology
- Pharmacology
Background:
- Systemic amyloidosis (AL) presents limited therapeutic options, especially after multiple treatment lines.
- Lenalidomide and dexamethasone combination therapy is effective but dexamethasone is poorly tolerated in cardiac AL patients.
- Lenalidomide monotherapy has modest activity, and combination therapy requires careful dosing due to dermatological adverse reactions.
Observation:
- A patient with AL, ineligible for stem cell transplant and intolerant to prior therapies, developed severe skin toxicity from lenalidomide.
- This patient had significant cardiac and renal impairment, posing a therapeutic challenge.
Findings:
- The patient was enrolled in a lenalidomide rapid desensitization program (RDP).
- Successful RDP treatment was achieved despite multi-organ impairments, with no recurrence of skin rash.
- This represents the first reported case of successful RDP in an AL patient with multi-organ dysfunction.
Implications:
- Lenalidomide rapid desensitization (RDP) offers a viable treatment strategy for AL patients experiencing severe skin toxicity.
- RDP allows for dose titration based on individual tolerance, potentially enabling achievement of target doses.
- This approach may expand treatment options for refractory AL patients with significant comorbidities.
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