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Case Reports
. 2024 Mar 1;16(3):e55317.
doi: 10.7759/cureus.55317. eCollection 2024 Mar.

Improved Side Effect Profile of Alternate-Day Dosing of Lenalidomide

Ridwan A Lawal  1 , Oluwole Banjoko  2 , Chukwunonso Ndulue  1 , Sodiq T Adebeshin  3 , Arsalan Sharif  4 , Osasumwen E Ighodaro  5 , Rahman Olusoji  6 , Bilikisu Odusanya  7 , Nadia S El-Hamdi  8
Affiliations
Case Reports

Improved Side Effect Profile of Alternate-Day Dosing of Lenalidomide

Ridwan A Lawal et al. Cureus. .

Abstract

Myelodysplastic syndrome (MDS) is a heterogeneous hematological condition associated with cytopenia, inadequate blood cell synthesis, and the risk of developing acute myeloid leukemia (AML). Patients are divided into risk groups according to the International Prognostic Scoring System (IPSS) to help direct therapy. Allogeneic stem cell transplantation, despite its limitations, is curative. Medical management, such as the use of lenalidomide, has potential benefits but can cause adverse effects that require dose regimen modification. Lenalidomide is approved for low-risk MDS with 5q deletion (5q- MDS). In this case study, a 79-year-old woman with 5q- MDS was switched from a daily regimen to an alternate-day lenalidomide dose schedule to achieve complete remission with fewer adverse effects. The management of hematological toxicity and the mechanisms of action of lenalidomide are discussed. We recommend individualized treatment strategies and additional research to improve MDS management.

Keywords: alternate day dosing; del(5q); lenalidomide; myelodysplastic syndrome (mds); resource limited setting.

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Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Figure 1
Figure 1. Hemoglobin, white blood cell count, and neutrophil count over 28 months
Figure 2
Figure 2. Platelets and MCV trend over 28 months
MCV: Mean corpuscular volume
Figure 3
Figure 3. Histopathological image of the hypercellular marrow with increased megakaryopoiesis (black arrow), H&E stain, original magnification 10x
H&E: Haematoxylin and eosin
Figure 4
Figure 4. Hypercellular bone marrow aspirate with increased megakaryopoiesis, H&E stain, original magnification 40x
The white arrow points to the megakaryocyte with a monolobated nucleus. H&E: Haemotoxylin and eosin
Figure 5
Figure 5. Increased megakaryopoiesis displayed on bone trephine H&E section, original magnification 40x
The white arrow points to a megakaryocyte. H&E: Haemotoxylin and eosin
See this image and copyright information in PMC

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