Multiple myeloma, Myelodysplastic syndrome

Angiogenesis Inhibitor; Antineoplastic Agent
Lenalidomide has immunomodulatory, antiangiogenic, and antineoplastic characteristics via multiple mechanisms. It selectively inhibits secretion of proinflammatory cytokines (potent inhibitor of tumor necrosis factor-alpha secretion); enhances cell-mediated immunity by stimulating proliferation of anti-CD3 stimulated T cells (resulting in increased IL-2 and interferon gamma secretion); inhibits trophic signals to angiogenic factors in cells. Inhibits the growth of myeloma, myelodysplastic, and lymphoma tumor cells by inducing cell cycle arrest and cell death.

1.Time to peak, plasma: MDS or myeloma patients: 0.5 to 6 hours.
2.Protein binding: ~30%.
3.Half-life elimination: 3 to 5 hours.
4.Excretion: Urine (~82%; as unchanged drug).

Severe hypersensitivity (eg, angioedema, Stevens-Johnson syndrome, toxic epidermal necrolysis) to lenalidomide or any component of the formulation; pregnancy.

Use of lenalidomide is contraindicated in pregnant patients. Lenalidomide is a thalidomide analogue, which is known to cause severe, life-threatening human birth defects.

Due to the potential for serious adverse reactions in the breastfed infant, breastfeeding is not recommended by the manufacturer.

1.Cardiovascular: Peripheral edema
2.Dermatologic: Pruritus , Rash
3.Endocrine metabolic: Hypokalemia , Weight decreased
4.Gastrointestinal: Constipation , Diarrhea, Nausea
5.Hematologic: Anemia, Leukopenia, Neutropenia, Thrombocytopenia
6.Musculoskeletal: Arthralgia , Backache, Cramp
7.Neurologic: Dizziness , Headache , Insomnia, Tremor
8.Respiratory: Bleeding from nose , Bronchitis, Cough , Nasopharyngitis

Multiple myeloma
1.Oral: 25 mg once daily on days 1 to 21 of a 28-day treatment cycle (in combination with dexamethasone [consider a reduced dexamethasone dose in patients >75 years of age]).
2.Maintenance therapy following autologous hematopoietic cell transplant: Oral: 10 mg once daily (begin after adequate hematologic recovery [ANC 1,000/mm3; platelets 75,000/mm3]); after 3 months (if tolerated and in the absence of hematologic toxicity), increase dose to 15 mg once daily.
Myelodysplastic syndrome
1.Transfusion-dependent anemia in patients at low or intermediate-1 risk with deletion 5q abnormality: 10 mg orally once daily until disease progression or unacceptable toxicity.

CrCl (mL/minute)	If the usual dose is 25 mg once daily	If the usual dose is 20 mg once daily	If the usual dose is 15 mg once daily	If the usual dose is 10 mg once daily
CrCl >60 mL/minute	No dosage adjustment necessary.	No dosage adjustment necessary.	No dosage adjustment necessary.	No dosage adjustment necessary.
CrCl 30 to 60 mL/minute	Initial: 10 mg once daily; if treating multiple myeloma, may increase to 15 mg once daily after 2 cycles if tolerating treatment.	Initial: 10 mg once daily; if treating follicular lymphoma or marginal zone lymphoma may increase to 15 mg once daily after 2 cycles if tolerating treatment.	Initial: 10 mg once daily.	Initial: 5 mg once daily.
CrCl 15 to <30 mL/minute	Initial: 15 mg every other day; if treating multiple myeloma, may increase dose to 10 mg once daily if tolerating treatment.	Initial: 5 mg once daily.	Initial: 5 mg once daily.	Initial: 2.5 mg once daily.
CrCl <15 mL/minute	Initial: 5 mg once daily.	Initial: 5 mg once daily.	Initial: 5 mg once daily.	Initial: 2.5 mg once daily.