Hyperbilirubinemia following lenalidomide administration

Abstract

Key Clinical MessageAsymptomatic hyperbilirubinemia in a patient with no underlying liver disease or renal impairment while on lenalidomide therapy may be attributable to the unmasking of previously undiagnosed Gilbert's syndrome, as previously shown in the literature. The hyperbilirubinemia should resolve after discontinuation of the drug.

Severe Lenalidomide-Associated Hyperbilirubinemia

“…In this case RUCAM was calculated at 6, indicating that DILI secondary to lenalidomide is probable. While there have been a handful of other reports of lenalidomide causing cholestatic liver injury [ 4 ], direct hyperbilirubinemia [ 6 ], unmasking Gilbert’s with indirect hyperbilirubinemia [ 7 , 8 ], idiosyncratic predominately hepatocellular injury [ 9 ], and rarely acute liver failure [ 4 ], to our knowledge this level of extremely elevated direct hyperbilirubinemia due to lenalidomide has not been reported in the literature. Notably, the patient had developed a significant AKI soon after starting lenalidomide, and as the drug is mainly renally excreted [ 6 ], the patient may have experienced a significant physiologic overdose, leading to more profound hyperbilirubinemia compared to previous reports.…”