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Ali SB, Lee WI, Horvath N, Le TTA, Smith W, Hissaria P. Lenalidomide Desensitization for Delayed Cutaneous Reaction: A Case Series and Review of the Literature. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IN PRACTICE 2023; 11:1503-1508. [PMID: 36738926 DOI: 10.1016/j.jaip.2023.01.036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Revised: 01/03/2023] [Accepted: 01/20/2023] [Indexed: 02/05/2023]
Abstract
BACKGROUND Lenalidomide is commonly used for treatment of multiple myeloma (MM) as well as other hematological disorders. Cutaneous adverse reactions occur frequently and withholding lenalidomide treatment may have implications for prognosis. OBJECTIVE To evaluate the role of lenalidomide desensitization in patients with cutaneous adverse reactions. METHODS A retrospective review of patients referred for lenalidomide desensitization between May 2019 and May 2022 at a tertiary hospital. All patients underwent a 6-week outpatient desensitization with premedication. RESULTS There were 12 patients: 10 males and 2 females with a median age of 65 years. All had MM with autologous stem cell transplantation and lenalidomide 10 mg daily added for maintenance therapy. Most patients (n = 8) had a generalized maculopapular exanthem with or without pruritus. All patients had delayed cutaneous reactions; the median time to onset was 14 days (range 2-28 d). Six patients tolerated desensitization: 5 on the first attempt and 1 after 3 attempts and supplementary oral prednisolone. Four patients underwent multiple (≤3) attempts at desensitization owing to breakthrough symptoms. In patients who failed desensitization, recurrence of symptoms occurred variably, either early (within days), within weeks, or delayed by more than 1 month. CONCLUSIONS Lenalidomide desensitization is worthwhile and allows continuation of treatment. In our MM cohort, lenalidomide desensitization was successful in only 50% of cases, including some cases in whom ongoing symptoms were mitigated by cotreatment with antihistamine.
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Affiliation(s)
- Syed B Ali
- Department of Clinical Immunology and Allergy, Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Wei-I Lee
- Department of Clinical Immunology and Allergy, Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Noemi Horvath
- Department of Haematology, Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Thanh-Thao Adriana Le
- Department of Clinical Immunology and Allergy, Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - William Smith
- Department of Clinical Immunology and Allergy, Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Pravin Hissaria
- Department of Clinical Immunology and Allergy, Royal Adelaide Hospital, Adelaide, South Australia, Australia; Department of Immunopathology, SA Pathology, Adelaide, South Australia, Australia.
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Zhou H, Li M, Zeng C, Chen Z, Zhang T, Cheng Z. Efficacy of Immunomodulatory Drugs in Combination With Dexamethasone in Proliferative Glomerulonephritis With Monoclonal Immunoglobulin Deposits. Kidney Int Rep 2022; 7:2166-2175. [PMID: 36217516 PMCID: PMC9546741 DOI: 10.1016/j.ekir.2022.07.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Revised: 06/16/2022] [Accepted: 07/11/2022] [Indexed: 10/25/2022] Open
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Sugi T, Mita M, Yasu T, Kubo K, Kushi R, Hanai H, Ohara S, Uchida T, Inoue M, Hagihara M. Preceding bortezomib administration for a certain period reduces the risk of lenalidomide-induced skin rash. J Clin Pharm Ther 2021; 47:477-482. [PMID: 34778985 DOI: 10.1111/jcpt.13568] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Revised: 10/25/2021] [Accepted: 11/01/2021] [Indexed: 11/29/2022]
Abstract
WHAT IS KNOWN AND OBJECTIVE It was previously reported that the incidence of lenalidomide (LEN)-induced skin rash is reduced by administration of bortezomib (BOR) prior to LEN administration in patients with multiple myeloma (MM). Therefore, we investigated whether LEN-induced skin rash is affected by the duration of BOR administration and the dosing interval between BOR and LEN administration. METHOD A retrospective investigation was conducted among MM patients who received BOR treatment prior to LEN treatment in Eiju General Hospital from May 2010 to December 2020. We investigated whether the BOR administration duration and interval duration from the completion of BOR administration to the initial LEN administration affect the development of LEN-induced skin rash. RESULT AND DISCUSSION Twenty-eight of the 81 patients exhibited LEN-induced skin rash (34.6%). The administered duration, but not the interval, was significantly longer in the group without skin rash. Cut-off values were set for the duration of administration and interval, which were 35 days and 30 days, respectively. Multivariate analysis was performed on patients which are administered duration of more than 35 days and intervals of less than 30 days, and those who are not applicable. A significant difference was observed in the incidence of skin rash for each factor. WHAT IS NEW AND CONCLUSION The risk of reduced LEN-induced skin rash is affected not only by the presence of prior BOR administration, but also by the duration of BOR and the interval from the completion of BOR to the initial LEN administration.
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Affiliation(s)
- Tomiyuki Sugi
- Department of Pharmacy, Eiju General Hospital, Taito-ku, Japan.,Department of Cardiovascular Pharmacology, Education and Research Unit for Comprehensive Clinical Pharmacy, Meiji Pharmaceutical University, Kiyose, Japan
| | - Mitsuo Mita
- Department of Cardiovascular Pharmacology, Education and Research Unit for Comprehensive Clinical Pharmacy, Meiji Pharmaceutical University, Kiyose, Japan
| | - Takeo Yasu
- Department of Medicinal Therapy Research, Pharmaceutical Education and Research Center, Meiji Pharmaceutical University, Kiyose, Japan
| | - Kana Kubo
- Department of Pharmacy, Eiju General Hospital, Taito-ku, Japan
| | - Ryota Kushi
- Department of Pharmacy, Eiju General Hospital, Taito-ku, Japan
| | - Homare Hanai
- Department of Pharmacy, Eiju General Hospital, Taito-ku, Japan
| | - Shin Ohara
- Department of Hematology, Eiju General Hospital, Taito-ku, Japan
| | - Tomoyuki Uchida
- Department of Hematology, Eiju General Hospital, Taito-ku, Japan
| | - Morihiro Inoue
- Department of Hematology, Eiju General Hospital, Taito-ku, Japan
| | - Masao Hagihara
- Department of Hematology, Eiju General Hospital, Taito-ku, Japan
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Immunomodulatory drugs suppress Th1-inducing ability of dendritic cells but enhance Th2-mediated allergic responses. Blood Adv 2021; 4:3572-3585. [PMID: 32761232 DOI: 10.1182/bloodadvances.2019001410] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2019] [Accepted: 05/01/2020] [Indexed: 11/20/2022] Open
Abstract
Immunomodulatory drugs (IMiDs), lenalidomide and pomalidomide, are widely used treatments for multiple myeloma; however, they occasionally lead to episodes of itchy skin and rashes. Here, we analyzed the effects of IMiDs on human myeloid dendritic cells (mDCs) as major regulators of Th1 or Th2 responses and the role they play in allergy. We found that lenalidomide and pomalidomide used at clinical concentrations did not affect the survival or CD86 and OX40-ligand expression of blood mDCs in response to lipopolysaccharide (LPS) and thymic stromal lymphopoietin (TSLP) stimulation. Both lenalidomide and pomalidomide dose-dependently inhibited interleukin-12 (IL-12) and TNF production and STAT4 expression, and enhanced IL-10 production in response to LPS. When stimulated with TSLP, both IMiDs significantly enhanced CCL17 production and STAT6 and IRF4 expression and promoted memory Th2-cell responses. In 46 myeloma patients, serum CCL17 levels at the onset of lenalidomide-associated rash were significantly higher than those without rashes during lenalidomide treatment and those before treatment. Furthermore, serum CCL17 levels in patients who achieved a very good partial response (VGPR) were significantly higher compared with a less than VGPR during lenalidomide treatment. The median time to next treatment was significantly longer in lenalidomide-treated patients with rashes than those without. Collectively, IMiDs suppressed the Th1-inducing capacity of DCs, instead promoting a Th2 response. Thus, the lenalidomide-associated rashes might be a result of an allergic response driven by Th2-axis activation. Our findings suggest clinical efficacy and rashes as a side effect of IMiDs are inextricably linked through immunostimulation.
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Sugi T, Mita M, Yasu T, Ohara S, Uchida T, Inoue M, Hagihara M. Simple desensitization protocol for multiple myeloma patients with lenalidomide-induced skin rash: Case series. J Clin Pharm Ther 2021; 46:1792-1795. [PMID: 33960000 DOI: 10.1111/jcpt.13433] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Revised: 03/31/2021] [Accepted: 04/19/2021] [Indexed: 11/29/2022]
Abstract
WHAT IS KNOWN AND OBJECTIVE Skin rash is one of the typical side effects of lenalidomide (LEN) treatment. Desensitization therapies have been reported to be effective in patients with severe skin rash caused by LEN. However, they have proved impractical due to the complexity of the protocols. CASE SUMMARIES We present 5 patients who developed severe LEN-induced skin rash. The five patients received our simple, slow desensitization protocol, and all were re-administered LEN with no adverse reaction. WHAT IS NEW AND CONCLUSION Our simpler and slow desensitization protocol, which desensitizes the patients without reducing the effect of LEN, includes drug holidays, similar to the usual LEN dosing schedule, and moreover is recommended as a treatment option especially for elderly patients with no housemate to help with medical management.
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Affiliation(s)
- Tomiyuki Sugi
- Department of Pharmacy, Eiju General Hospital, Taito-ku, Japan.,Department of Cardiovascular Pharmacology, Education and Research Unit for Comprehensive Clinical Pharmacy, Meiji Pharmaceutical University, Kiyose, Japan
| | - Mitsuo Mita
- Department of Cardiovascular Pharmacology, Education and Research Unit for Comprehensive Clinical Pharmacy, Meiji Pharmaceutical University, Kiyose, Japan
| | - Takeo Yasu
- Department of Medicinal Therapy Research, Pharmaceutical Education and Research Center, Meiji Pharmaceutical University, Kiyose, Japan
| | - Shin Ohara
- Department of Hematology, Eiju General Hospital, Taito-ku, Japan
| | - Tomoyuki Uchida
- Department of Hematology, Eiju General Hospital, Taito-ku, Japan
| | - Morihiro Inoue
- Department of Hematology, Eiju General Hospital, Taito-ku, Japan
| | - Masao Hagihara
- Department of Hematology, Eiju General Hospital, Taito-ku, Japan
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Sugi T, Nishigami Y, Saigo H, Hanai H, Takabatake K, Mita M, Ohara S, Ide S, Uchida T, Inoue M, Hagihara M. Analysis of risk factors for lenalidomide-associated skin rash in patients with multiple myeloma. Leuk Lymphoma 2021; 62:1405-1410. [DOI: 10.1080/10428194.2021.1876867] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Affiliation(s)
- Tomiyuki Sugi
- Department of Pharmacy, Eiju General Hospital, Tokyo, Japan
- Department of Cardiovascular Pharmacology, Education and Research Unit for Comprehensive Clinical Pharmacy, Meiji Pharmaceutical University, Kiyose, Japan
| | | | - Hirohisa Saigo
- Department of Pharmacy, Eiju General Hospital, Tokyo, Japan
| | - Homare Hanai
- Department of Pharmacy, Eiju General Hospital, Tokyo, Japan
| | | | - Mitsuo Mita
- Department of Cardiovascular Pharmacology, Education and Research Unit for Comprehensive Clinical Pharmacy, Meiji Pharmaceutical University, Kiyose, Japan
| | - Shin Ohara
- Department of Hematology, Eiju General Hospital, Tokyo, Japan
| | - Shiro Ide
- Department of Hematology, Eiju General Hospital, Tokyo, Japan
| | - Tomoyuki Uchida
- Department of Hematology, Eiju General Hospital, Tokyo, Japan
| | - Morihiro Inoue
- Department of Hematology, Eiju General Hospital, Tokyo, Japan
| | - Masao Hagihara
- Department of Hematology, Eiju General Hospital, Tokyo, Japan
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Takamatsu H, Iida S, Shibayama H, Shibayama K, Yamazaki H, Suzuki K. Daratumumab, lenalidomide, and dexamethasone in Japanese patients with transplant-ineligible newly diagnosed multiple myeloma: a phase 1b study. Int J Hematol 2020; 111:692-701. [PMID: 32002821 DOI: 10.1007/s12185-020-02825-w] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2019] [Revised: 01/07/2020] [Accepted: 01/07/2020] [Indexed: 12/29/2022]
Abstract
Lenalidomide and dexamethasone (Rd) treatment is common for patients with newly diagnosed multiple myeloma (NDMM) ineligible for autologous stem-cell transplantation. Daratumumab plus Rd (D-Rd) is effective and well tolerated for treating relapsed or refractory multiple myeloma. In this ongoing phase 1b trial, transplant-ineligible Japanese patients with NDMM received daratumumab (16 mg/kg intravenously every week for 8 weeks, every 2 weeks for 16 weeks, then every 4 weeks until disease progression) plus Rd (R 25 mg on Days 1‒21 of 28-day cycle; d 40 mg weekly). The primary objective was to evaluate D-Rd tolerability and safety in Japanese patients with NDMM. Secondary objectives included daratumumab pharmacokinetics and response rate. During the dose-limiting toxicity (DLT) evaluation period, two DLTs occurred in seven (28.6%) patients, indicating D-Rd tolerability. At an 11.0-month median follow-up (interim analysis), grade 3/4 treatment-emergent adverse events occurred in six (85.7%) patients, including lymphopenia (71.4%), leukopenia (57.1%), and neutropenia (42.9%). Three (42.9%) patients experienced infusion-related reactions (IRRs). All IRRs were grade 2, occurred during the first daratumumab infusion, and resolved within 24 h. Pharmacokinetic findings were comparable to those in previous studies. A 100% overall response rate was achieved. These findings suggest D-Rd is tolerable in Japanese patients with transplant-ineligible NDMM. ClinicalTrials.gov identifier NCT02918331.
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Affiliation(s)
- Hiroyuki Takamatsu
- Department of Hematology, Faculty of Medicine, Institute of Medical, Pharmaceutical, and Health Sciences, Kanazawa University, 13-1 Takaramachi, Kanazawa, Ishikawa, 920-8641, Japan.
| | - Shinsuke Iida
- Department of Hematology and Oncology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Hirohiko Shibayama
- Department of Hematology and Oncology, Osaka University Graduate School of Medicine, Suita, Japan
| | - Kazuhiro Shibayama
- Janssen Pharmaceutical K.K., Research & Development Division, Tokyo, Japan
| | - Hiroshi Yamazaki
- Janssen Pharmaceutical K.K., Research & Development Division, Tokyo, Japan
| | - Kenshi Suzuki
- Department of Hematology, Japanese Red Cross Medical Center, Tokyo, Japan
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