Severe Lenalidomide-Associated Hyperbilirubinemia

Area of Science:

• Hepatology
• Pharmacology
• Oncology

Background:

• Immunomodulatory drugs (IMids), including lenalidomide, are standard treatments for plasma cell neoplasms and B-cell malignancies.
• Drug-induced liver injury (DILI) is a potential adverse effect of many medications, necessitating careful patient monitoring.

Observation:

• A case study involving a patient with plasmacytoma receiving lenalidomide-based therapy.
• The patient developed severe direct hyperbilirubinemia, with peak bilirubin levels reaching 41 mg/dL.
• Initial investigations including imaging and liver biopsy did not reveal significant structural abnormalities, showing only mild sinusoidal dilation.

Findings:

• The Roussel Uclaf Causality Assessment (RUCAM) score of 6 strongly suggested lenalidomide as the probable cause of the drug-induced liver injury (DILI).
• This case represents the highest reported level of direct hyperbilirubinemia associated with lenalidomide-induced DILI in the current literature.

Implications:

• This case underscores the importance of vigilant monitoring for liver injury, particularly severe hyperbilirubinemia, in patients undergoing lenalidomide treatment.
• While the exact mechanism remains unclear, this report contributes to the understanding of lenalidomide's potential hepatotoxicity and informs clinical safety protocols.