Simple desensitization protocol for multiple myeloma patients with lenalidomide‐induced skin rash: Case series

Abstract

Lenalidomide (LEN), one of the immunomodulatory drugs (IMiDs), is widely used in combination with dexamethasone (DEX) to treat patients with multiple myeloma (MM), from primary to relapsed/refractory cases. Furthermore, LEN may also be administered in combination with a proteasome inhibitor (PI; bortezomib, carfilzomib or ixazomib) or an antibody drug (elotuzumab or daratumumab) and is a key drug for MM treatment. On the other hand, LEN is also known to have a higher incidence of skin rash compared with other IMiDs. [1][2][3] This may disrupt the treatment continuation and may also significantly reduce the patient's quality of life. The incidence of skin rash caused by Len is reported to be 9.7-50.0%. [4][5][6][7] There are a few case reports of desensitization therapies by LEN in patients with LEN-induced hypersensitivity and skin rash. [8][9][10][11][12] However, they are difficult to apply clinically since the schedule of administration is complicated or there is a risk that pharmacists may be exposed when preparing the drug. Therefore, we have changed the desensitization protocols reported previously to a simple one, which can be easily performed on elderly MM patients.

Desensitization protocol to lenalidomide: An effective and safe treatment modality for delayed hypersensitivity‐induced rash in patients with multiple myeloma

“…Several studies regarding desensitization protocols to lenalidomide‐induced delayed rash in MM patients have been published 1,7,8,10,12,13,18 . Unlike previous reports of risk for lenalidomide‐induced skin rashes, 14 patient ages and comorbidities were not found to be associated with the success of the desensitization protocol. If lenalidomide hypersensitivity reactions are so common, it is peculiar to find scant reports of desensitized patients to date.…”

“…Several studies regarding desensitization protocols to lenalidomide-induced delayed rash in MM patients have been published. 1,7,8,10,12,13,18 Unlike previous reports of risk for lenalidomide-induced skin rashes, 14 patient ages and comorbidities…”

“…9 In a real-world setting this may be as high as 44% of patients. 14,15 Different treatment strategies are commonly applied in these patients, including oral antihistamines and topical or systemic corticosteroids. However, in some MM patients, delayed hypersensitivity will still result in discontinuation of lenalidomide, a loss of an important therapeutic modality.…”

“…A meta‐analysis of ten different studies found that rash was evident in 27.2% of treated patients 9 . In a real‐world setting this may be as high as 44% of patients 14,15 . Different treatment strategies are commonly applied in these patients, including oral antihistamines and topical or systemic corticosteroids.…”

Management of adverse reactions induced by chemotherapy drugs

“…The performance of SDD in chemotherapy is a matter of research as its procedures are not standardized [16 ▪ ]. Recently, a case series of five patients with a delayed skin rash after treatment with lenalidomide showed efficacy and tolerance to a 3-week SDD [16 ▪ ]. Moreover, patients with delayed hypersensitivity reactions can undergo RDD but reports of its efficacy are scarce.…”