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Lenalidomide long-term neurotoxicity: Clinical and neurophysiologic prospective study
Chiara Dalla Torre1, Renato Zambello1, Mario Cacciavillani1
1From the Department of Neurosciences (C.D.T., M. Campagnolo, A.S., M.L., M.E., C.B.) and the Medicine, Haematology and Clinical Immunology Branch (R.Z., T.B., E.D.M., G.B., A.L.), University of Padova; and CEMES-EMG Lab (M. Cacciavillani), Data Medica Group, Padova, Italy.
Neurology
|August 19, 2016
Summary
Long-term lenalidomide therapy in multiple myeloma patients can lead to sensory axonal neuropathy in up to 50% of cases. This neurotoxicity appears unrelated to the cumulative drug dose or treatment response.
Area of Science:
- Neuroscience
- Oncology
- Pharmacology
Background:
- Lenalidomide is a key treatment for relapsed/refractory multiple myeloma.
- Long-term neurotoxicity is a potential concern with lenalidomide therapy.
- Understanding lenalidomide's neurotoxic effects is crucial for patient management.
Purpose of the Study:
- To assess long-term lenalidomide-induced neurotoxicity in multiple myeloma patients.
- To investigate the relationship between cumulative lenalidomide dose and neurotoxicity.
- To explore the correlation between lenalidomide neurotoxicity and hematologic response.
Main Methods:
- Nineteen multiple myeloma patients receiving lenalidomide underwent clinical and neurophysiologic assessments.
- Assessments were conducted at baseline and at 2 or 5 years post-treatment initiation.
- Neuropathy was evaluated using the Total Neuropathy Score clinical version (TNSc), and correlations were analyzed.
Main Results:
- Neurophysiologic evidence of sensory axonal neuropathy was observed in 4/8 patients at 2 years and 3/11 patients at 5 years.
- Reduced dorsal sural nerve sensory action potential amplitude was the earliest neurophysiologic abnormality.
- No significant clinical neuropathy (TNSc ≥4) or correlation between lenalidomide dose/hematologic response and neuropathy was found.
Conclusions:
- Long-term lenalidomide therapy can result in sensory axonal neuropathy in up to 50% of multiple myeloma patients.
- The neuropathy is typically subclinical or mild, with reduced dorsal sural nerve sensory action potential amplitude as an early sign.
- Lenalidomide-induced neurotoxicity appears independent of cumulative dose and hematologic response.
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