Lenalidomide induced graft-versus-host disease in a patient with relapsed multiple myeloma three and a half years after allogeneic hematopoietic stem cell transplantation

Abstract

Lenalidomide is indicated for treatment of patients with relapsed or refractory multiple myeloma. The main toxicities related to this drug are severe neutropenia and thrombocytopenia. Lenalidomide-associated eosinophilic pneumonia with skin rash is rare. We report a patient who developed dyspnea with skin rash during lenalidomide treatment for relapsed myeloma three and a half years after allogeneic hematopoietic stem cell transplantation (allo- HSCT). Bronchoalveolar lavage (BAL) analysis revealed increased eosinophils, but no sign of infection. Skin biopsy findings showed graft-versus-host disease (GVHD). We made a diagnosis of eosinophilic pulmonary syndrome associated with GVHD. This case suggests that even three and a half years after performing allo-HSCT, lenalidomide therapy may induce GVHD. Consequently, lenalidomide therapy in such patients should be applied carefully while taking GVHD into consideration.