Lenalidomide-Associated Immune Thrombocytopenia: A Case Report and Review of the Literature

Abstract

Lenalidomide is indicated in the front-line management of multiple myeloma. More recently, it has been introduced for use in treating other hematologic malignancies. Although the drug is known to cause myelosuppression, there have been rare reports of lenalidomide-associated immune thrombocytopenia (ITP). Here, we review the literature on lenalidomide-associated ITP and report upon a 59-year-old man who was administered lenalidomide due to concern of progressive multiple myeloma more than a year following his having undergone an autologous hematopoietic stem cell transplant. His platelet count precipitously declined and lead to his hospitalization. Despite our withholding of the drug, he did not respond to platelet transfusions or administration of corticosteroids. He was successfully managed with intermittent immune globulin for several months before definitive treatment with splenectomy, which resulted in the complete resolution of his thrombocytopenia. A literature search identified a total of six additional cases of lenalidomide-associated ITP. Similarly, many of the reported cases were associated with persistent thrombocytopenia after discontinuation of the drug. Furthermore, these patients were generally managed successfully with standard ITP therapies, such as corticosteroids or intravenous immune globulin.

Figure 1

Bone marrow biopsy (200x). The bone marrow is normocellular with adequate trilineage hematopoiesis and normal maturation. Several megakaryocytes are present.

Figure 2

The platelet count and treatment history of the case.

Figure 3

The spleen was 244.5 gm showing red pulp congestion, but no abnormal cell population. The perivascular white pulp is intact but attenuated.

Figure 4

Literature search results, exclusion, and inclusion. A MEDLINE search for the keywords (lenalidomide) and (ITP) or (lenalidomide) and (immune thrombocytopenia) resulted in 24 results. 23 of these results were excluded, and 1 was assessed and included. Google Scholar was also searched using the keywords (lenalidomide) and (ITP). There were 569 results. 566 of these results were assessed and excluded as not related to lenalidomide and ITP. 3 of the 569 results were included in our report. Because one of the included Google Scholar results was a duplicate with the included MEDLINE, there were a total of 3 reports that were identified that those were case reports or case series of lenalidomide-associated ITP.