Dermatological complications following initiation of lenalidomide in a patient with chronic lymphocytic leukaemia

Abstract

Off-label use of lenalidomide (Len) in chronic lymphocytic leukemia (CLL) is becoming increasingly frequent. When compared with thalidomide, Len has been reported to have more potent anti-tumour activity and a better safety profile. However, dermatological side-effects are known to occur with both drugs. Clinical trial design often precludes precise quantification of infrequent toxicities and studies frequently report only grade 3-4 toxicities without a detailed description of rashes, leading to under-recognition of these complications in the community. Careful long-term tracking of late adverse effects with prompt reporting on recognition is imperative while monitoring patients for potential adverse events as we enter the new era of targeted therapies. We present an unusual case of CLL that was complicated by erythema annulare centrifugum and neutrophilic dermatosis (Sweet's syndrome) after starting Len.

Rituximab for refractory subcutaneous Sweet's syndrome in chronic lymphocytic leukemia: A case report

“…Sweet's syndrome is usually accompanied with evidence suggesting the onset, relapse or recurrence of the underlying malignancy in similar reports (3,5,(10)(11)(12). However, in our patient, the leukemia was in remission.…”

Insight into Sweet’s syndrome and associated-malignancy: A review of the current literature

“…Another patient is reported with Sweet's syndrome in chronic lymphocytic leukemia who was treated with lenalidomide. The patient responded successfully to prednisone therapy (43). In a recently published study, the severity of lenalidomide-associated tumor flare reactions in CLL patients correlated directly with in vitro lenalidmide-induced upregulation of CD80 on CLL cells and CD69 expression on T cells (T-cell activation) and inversely with treatment-induced changes in T-cell numbers.…”

“…In a recently published study, the severity of lenalidomide-associated tumor flare reactions in CLL patients correlated directly with in vitro lenalidmide-induced upregulation of CD80 on CLL cells and CD69 expression on T cells (T-cell activation) and inversely with treatment-induced changes in T-cell numbers. A striking increase in the levels of IL-6 and TNF-α was seen in the patient with the most severe reaction, suggesting 'immune-activation' as the most likely culprit (43,44).…”

“…Other medications that are frequently associated with Sweet's syndrome include bortezomib, hypomethylating agents (azacitidine, decatibine), imatinib, lenalidomide and all-trans retinoic acid. Table III describes the most commonly reported anticancer agents with Sweet's syndrome (26,(31)(32)(33)(34)(35)(36)(37)(38)(39)(40)(41)(42)(43)(44)(45)(46). Table II.…”

In Vitro, Molecular Docking, and In Silico Binding Mode Analysis of Organic Compounds for Antimicrobial and Anticancer Activity against Jurkat, HCT116, and A549 Cell Lines.

“…[7] N. Nateja et al reported dermatological complications in patients underwent lenalidomide treatment. [8] Imbruvica is another anticancer targeted therapy drug leading in the market, which works by the mechanism of irreversible binding to Bruton Tyrosine Kinase (BTK) molecule at BTK cysteine-481 ATP binding site, thereby inhibiting the phosphorylation of down-stream PLC-c2, and B-cell receptor signaling. However, a long period of administration of imbruvica can lead to chronic lymphocytic leukaemia, atrial fibrillation, bleeding risk, and side drug interactions.…”