A case of gastrointestinal graft-versus-host-disease after initiating lenalidomide for relapsed multiple myeloma after allogeneic stem cell transplantation

Abstract

A 34-year-old woman with IgA-λ type multiple myeloma was treated with combination chemotherapy followed by highdose chemotherapy supported by autologous stem cell transplantation (SCT), and then underwent allogeneic SCT from an unrelated donor. Although she achieved a complete response, the disease relapsed 7 months after allogeneic SCT and lenalidomide was initiated. Nine days after starting lenalidomide, she complained of diarrhea and nausea. Colonoscopy showed edematous and erosive changes on colonic epithelium mucosa, and histological findings were consistent with graft-versus-hostdisease (GVHD). Lenalidomide was discontinued and glucocorticoid was initiated, resulting in a prompt resolution of the symptoms. Although sporadic cases of GVHD after initiating lenalidomide in allogeneic SCT recipients have been reported, such case has not been reported from Japanese population. Physicians should be aware of the possibility of developing GVHD by the administration of lenalidomide after allogeneic SCT.