Makindo Medical Notes

⚠️ Patients receiving lenalidomide for management of multiple myeloma should be closely monitored for signs of arterial or venous thromboembolism. 💉 Always prescribe with antithrombotic prophylaxis when combined with corticosteroids or chemotherapy.

💊 About

Lenalidomide is an immunomodulatory agent (IMiD) and a molecular analogue of thalidomide with enhanced potency and fewer sedative effects. It has revolutionised the treatment of multiple myeloma, myelodysplastic syndromes, and some lymphomas. It is administered orally and is tightly regulated under pregnancy prevention programmes due to its teratogenic potential.

📖 About: Always check the BNF link here

• 📚 Check BNF or equivalent for up-to-date prescribing advice.
• 🧬 Molecular analogue of thalidomide with improved efficacy and tolerability.

⚙️ Mode of Action

• 🎯 Exhibits anti-neoplastic, anti-angiogenic, and pro-erythropoietic properties.
• 🧩 Binds to cereblon (CRBN), modifying ubiquitin ligase activity → degradation of key transcription factors in myeloma cells.
• 🔄 Enhances T-cell and NK-cell activity while reducing pro-inflammatory cytokines like TNF-α.

📋 Indications

• 🦴 Multiple myeloma
• 🩸 Myelodysplastic syndromes (especially with 5q deletion)
• 🧠 Mantle cell lymphoma
• 🌿 Follicular lymphoma

💊 Typical Dosing (Check BNF)

Note: Dose varies by indication, renal function, and combination regimen.

⚖️ Interactions

• 💊 See BNF — risk increases with corticosteroids, cytotoxics, or erythropoietin.
• ⚠️ Additive thrombotic risk with other pro-coagulants.

⚠️ Cautions

• 📈 Monitor full blood count regularly (risk of neutropenia and thrombocytopenia).
• 🦵 Monitor for thromboembolism; consider LMWH or aspirin prophylaxis.
• 🚻 Strict adherence to pregnancy prevention programme (REMS equivalent in UK).

⛔ Contraindications

• 🤰 Pregnancy — may cause severe birth defects or foetal death. Females of childbearing potential must use two reliable forms of contraception and undergo regular testing.
• 🚫 Hypersensitivity to lenalidomide or thalidomide.

💥 Adverse Effects

• 🩸 Myelosuppression — neutropenia, thrombocytopenia (dose-limiting).
• ⚡ Peripheral neuropathy (less frequent than thalidomide).
• 🫀 Thromboembolic events — both arterial and venous.
• 🌡️ Rash, pruritus, fever.
• 🔥 Severe mucocutaneous reactions — Stevens-Johnson syndrome or toxic epidermal necrolysis (rare).

🧠 Teaching & Pathophysiology

Lenalidomide refines the thalidomide concept by targeting cereblon-dependent transcriptional pathways essential for myeloma cell survival. It promotes apoptosis and immune recognition while reducing the marrow microenvironment’s cytokine support. Clinically, it exemplifies how molecular design can turn a toxic predecessor into a precision anti-cancer therapy. 🌟

📚 References

• 💼 SmPC Guidance
• 📖 BNF: Lenalidomide
• Rajkumar SV, *N Engl J Med* 2020;382:194–204.

💡 Teaching tip: Remember the “3 Ts” for lenalidomide — Teratogenicity, Thrombosis, Thrombocytopenia. These are high-yield for MLA and MRCP questions.