Successful desensitization procedure to lenalidomide in a patient with delayed hypersensitivity confirmed with a positive LTT

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

“…Lenalidomide, a synthetic immunomodulatory (IMiD) derivative of thalidomide, is used to treat patients with multiple myeloma (MM), lymphoma, and myelodysplastic syndrome. 5,17 In MM, it is given in various combinations with dexamethasone and other agents and is considered a standard of care. 5,18 Lenalidomide mechanism of action involves modulation of the substrate specificity of the CRL4 CRBN E3 ubiquitin ligase.…”

“…8 In clinical trials, rash was reported in up to one-third of lenalidomide-treated patients. 17 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.…”

“…However, in some MM patients, delayed hypersensitivity will still result in discontinuation of lenalidomide, a loss of an important therapeutic modality. 17 An alternative approach is therefore needed.…”

“…This is defined by a rash, which appears after >48 h of drug exposure 8 . In clinical trials, rash was reported in up to one‐third of lenalidomide‐treated patients 17 . A meta‐analysis of ten different studies found that rash was evident in 27.2% of treated patients 9 .…”

“…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 17 . An alternative approach is therefore needed.…”