B-Lymphoblastic Leukemia with BCR::ABL1-like Features After Long-term Lenalidomide Therapy.

Area of Science:

• Hematology
• Oncology
• Pharmacology

Background:

• Lenalidomide, an immunomodulatory drug (IMiD), is a standard treatment for multiple myeloma (MM).
• Long-term MM survival increases risk for secondary primary malignancies (SPMs).
• IMiDs are associated with increased risks of acute myeloid leukemia (AML), myelodysplastic neoplasms (MDS), and skin cancers.

Purpose of the Study:

• To report a rare case of B-lymphoblastic leukemia (B-ALL) developing after prolonged lenalidomide maintenance therapy for MM.
• To highlight the potential risk of B-ALL as a secondary malignancy in MM patients treated with lenalidomide.

Main Methods:

• Case report of an elderly male patient with MM.
• Review of patient's treatment history including 10 years of lenalidomide maintenance.
• Diagnosis of B-ALL following presentation with pancytopenia.

Main Results:

• The patient developed B-ALL after a decade of lenalidomide therapy for MM.
• This represents a rare instance of B-ALL as a secondary malignancy in this context.
• The patient also had a history of multiple skin cancers.

Conclusions:

• Long-term lenalidomide therapy may be associated with an increased risk of B-ALL.
• Physicians should monitor MM patients on long-term IMiD therapy for potential secondary hematologic malignancies.
• This case underscores the importance of vigilance for SPMs in patients with hematologic malignancies.