Lenalidomide
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Pulmonary toxicity: case report A 62-year-old man developed pulmonary toxicity while receiving lenalidomide for multiple myeloma. The man was referred for evaluation of progressive dyspnoea associated with fatigue, a dry cough, and an abnormal chest CT. He had been diagnosed with multiple myeloma in February 2007, and had received 4 cycles of thalidomide and dexamethasone followed by autologous stem cell transplantation. Progressive multiple myeloma developed in December 2009, and in January 2010 he was commenced on dexamethasone and lenalidomide 25mg daily on days 1–21 of a 28-day cycle [route not stated]. After 2 cycles he reported profound fatigue, cough and dyspnoea. He experienced difficulty performing his activities of daily living, and was using a wheelchair. Physical examination showed faint rales at the base of both lungs and trace lower extremity oedema. Chest CT was normal. Pulmonary drug toxicity was suspected, and the man’s lenalidomide treatment was stopped. His dyspnoea and cough improved within 2 weeks. A chest CT scan revealed new peripheral reticulation with architectural distortion and ground-glass opacities indicative of nonspecific interstitial pneumonia or drug-related pulmonary toxicity. However, his symptoms dramatically improved within 1 month after stopping lenalidomide, and a repeat chest CT scan showed pronounced improvement in the previous findings. In June 2010, his exercise tolerance had returned to normal, and he reported complete resolution of his cough and dyspnoea. Author comment: "[L]enalidomide can cause pulmonary toxicity. In the case described herein, the Naranjo score, which helps define the relationship of a side effect and potential drug toxicity was 6, which is consistent with a ‘probable’ adverse drug reaction". Coates S, et al. Reversible pulmonary toxicity due to lenalidomide. Journal of Oncology Pharmacy Practice 18: 284-286, No. 2, 2012. Available from: URL: 803084590 http://dx.doi.org/10.1177/1078155211408374 - USA
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Reactions 16 Mar 2013 No. 1443
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