Khan DSR, Tariq DM, Fayyaz DSM, Soomar SM, Moosajee DM. Lenalidomide induced secondary Acute Lymphoblastic Leukemia in a Multiple Myeloma patient: A case-report.
Leuk Res Rep 2022;
17:100315. [PMID:
35462726 PMCID:
PMC9026623 DOI:
10.1016/j.lrr.2022.100315]
[Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Revised: 03/09/2022] [Accepted: 04/11/2022] [Indexed: 11/18/2022] Open
Abstract
This case highlights the importance of close follow-up of patients on long-term lenalidomide therapy, particularly for the development of secondary malignancies.
Any change in blood counts that cannot be attributed to the progression of the underlying disease should be worked up for therapy-related hematological malignancies.
The benefits and risk of maintenance therapy with lenalidomide verse risk of developing Secondary malignancies should be discussed with patients.
Lenalidomide mechanism of action has been shown to modulate the different components of the immune system. A 68-year-old lady presented to us with severe backache and was then diagnosed with MM. Lenalidomide started as per protocol along with dexamethasone. Later, she presented with complaints of generalized weakness and her workup showed significant blast cells with Pan-B-cell markers consistent with secondary B-ALL. The reported incidence of secondary Acute Lymphocytic Leukemia is 2.3%. The development of more aggressive neoplasm in a patient with prior malignancy dictates a poor outcome and hence such patients should be enrolled in a clinical trial whenever available.
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