Kleder Stada (Lenalidomide)

Lenalidomide is used in hematologic malignancies that rely on abnormal plasma‑cell proliferation and ineffective hematopoiesis.

• Multiple myeloma: improves progression‑free and overall survival when combined with dexamethasone in relapsed or refractory disease.
• Myelodysplastic syndromes (del(5q)): reduces transfusion dependence and prolongs survival in patients with the 5q deletion.

• Lenalidomide binds to the cereblon component of the CRL4‑E3 ubiquitin ligase complex, triggering ubiquitination and proteasomal degradation of the transcription factors Ikaros and Aiolos. This leads to modulation of cytokine production, inhibition of angiogenesis, and direct anti‑proliferative and pro‑apoptotic effects on malignant plasma cells and dysplastic progenitors.

Lenalidomide may cause a range of adverse reactions that vary in frequency and severity.

Common Side Effects

• Fatigue: persistent tiredness affecting daily activities.
• Diarrhea: loose stools occurring intermittently.
• Nausea: mild to moderate upset stomach.
• Rash: skin redness or itching.
• Constipation: difficulty passing stool.
• Peripheral edema: swelling of the lower extremities.

Serious or Rare Side Effects

• Thromboembolic events: deep‑vein thrombosis or pulmonary embolism.
• Severe neutropenia: markedly reduced neutrophil count increasing infection risk.
• Hepatotoxicity: elevated liver enzymes or liver injury.
• Secondary malignancies: emergence of new cancers.
• Severe cutaneous reactions: Stevens‑Johnson syndrome or toxic epidermal necrolysis.

Before initiating therapy, clinicians should assess patient‑specific risk factors and monitor laboratory parameters regularly.

• Pregnancy testing: confirm negative result before starting; discontinue if pregnancy occurs.
• Thrombosis prophylaxis: consider anticoagulation in patients with additional risk factors.
• Renal function: adjust monitoring in patients with impaired clearance.
• Hepatic function: evaluate liver enzymes prior to and during treatment.
• Contraception: use effective methods during treatment and for at least four weeks after the last dose.
• Store at ambient temperature: keep in the original container, protect from moisture and direct sunlight.

Lenalidomide may interact with other medicines, altering efficacy or safety.

Major Interactions (Avoid)

• Strong CYP3A4 inducers: may reduce lenalidomide exposure.
• Anticoagulants (e.g., warfarin): increased risk of bleeding.

Moderate Interactions (Monitor Closely)

• P-glycoprotein inhibitors: may raise plasma concentrations.
• NSAIDs: additive risk of renal impairment.
• Vaccines: live vaccines should be avoided during therapy.