Reversible pulmonary toxicity due to lenalidomide

Abstract

Lenalidomide is a derivative of thalidomide and is FDA-approved for the treatment of myelodysplastic syndrome and, in combination with dexamethasone, for the treatment of relapsed multiple myeloma. Pulmonary toxicity with thalidomide is a recognized potential complication; however, there have only been two case reports in the literature of lenalidomide-associated pulmonary toxicity. In this case, we describe a patient who developed profound dyspnea, decreased exercisetolerance, and new ground-glass opacities with reticulation, consistent with a nonspecific interstitial pneumonia pattern. Clinical suspicion for pulmonary drug toxicity was high and lenalidomide was discontinued. Within 2 weeks of stopping lenalidomide, the patient had significant improvement in dyspnea and interstitial changes on CT were resolving. After 8 weeks, there was complete resolution of symptoms. Lenalidomide-induced pulmonary toxicity is significantly debilitating but, to date, it appears to be reversible with discontinuation of the medication.

Patient with Refractory Multiple Myeloma Developing Eosinophilia after Lenalidomide Treatment and Lung Cancer 9 Months Later: Case Report and Review of the Literature

“…Eosinophilia during treatment with lenalidomide is rare, with only 19 cases reported to date [1][2][3][4][5][6][7][8][9][10][11]. Of these, only five patients were under treatment with the drug for multiple myeloma.…”

Lenalidomide induced pneumonitis

“…Several case reports note patients developing pneumonitis after previous success with iMiD therapy. [5][6][7][8] The patient's second bronchoscopy exhibited an acute injury pattern often seen in AFOP. This type of pneumonia has been associated with hypersensitivity, infection, and drug toxicity, among other causes.…”

“…Case reports have documented several accounts of iMiD-related pneumonitis, radiographically exhibiting diffuse ground-glass opacities. 2–12 Three case reports were identified describing lung CT findings of micronodules, 2 parenchymal consolidations, 3 and reticulonodular opacities. 4 To our knowledge, this is the first recorded case of iMiD therapy causing a solid consolidative mass in this patient population.…”

“…Several case reports note patients developing pneumonitis after previous success with iMiD therapy. 5–8…”

Lenalidomide‐induced eosinophilic pneumonia

“…Lenalidomide has a favourable side effect profile in comparison to thalidomide secondary to reduced incidence of peripheral neuropathy . There are few published case reports of pulmonary toxicity due to lenalidomide and it is possible that the incidence is under‐reported . We have reviewed the literature and are adding to it by presenting a detailed clinico‐radiologic‐pathologic case of eosinophilic pneumonia while on lenalidomide for maintenance after ASCT.…”