Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

  • Case Study
  • Published:

Renal recovery with lenalidomide in a patient with bortezomib-resistant multiple myeloma

Nature Reviews Clinical Oncology volume 7, pages 289–294 (2010)Cite this article

Subjects

Abstract

Background. A 51-year-old man presented with an 8 month history of migratory pain and weakness.

Investigations. Conventional X-ray, MRI, laboratory investigations including serum electropheresis and immunofixation, measurement of the glomerular filtration rate and levels of serum creatinine and lactate dehydrogenase, and 24 h urine analysis for proteinuria.

Diagnosis. Durie–Salmon stage IIIB multiple myeloma with IgG λ gammopathy and renal impairment associated with urinary excretion of free λ light chains.

Management. Initially, the patient received supportive analgesia with metamizol and opioids, erythropoiesis-stimulating agents and monthly administration of bisphosphonates. A standard regimen of bortezomib, doxorubicin and dexamethasone was started, but the patient did not respond and developed severe renal failure. Treatment was switched to low-dose lenalidomide and high-dose dexamethasone. The lenalidomide dose was gradually increased up to 15 mg daily and the dexamethasone dose reduced to 40 mg once a week. Therapy was well tolerated, and the patient underwent autologous stem-cell transplantation around 16 months after start of induction treatment and 12 months after the start of lenalidomide-based therapy. At 2 years after initiation of lenalidomide-based therapy, the patient remains in partial remission with stable renal function and excellent performance status.

This is a preview of subscription content, access via your institution

Access options

Buy this article

  • Purchase on Springer Link
  • Instant access to full article PDF
Buy now

Prices may be subject to local taxes which are calculated during checkout

Figure 1: Proteinuria and creatinine levels during therapy in a patient with multiple myeloma and acute renal failure.
Figure 2: Treatment algorithm for patients with multiple myeloma.

References

  1. Jemal, A. et al. Cancer statistics, 2009. CA Cancer J. Clin. 59, 225–249 (2009).

    Article  PubMed  Google Scholar 

  2. Boyle, P. & Ferlay, J. Cancer incidence and mortality in Europe, 2004. Ann. Oncol. 16, 481–488 (2005).

    Article  CAS  PubMed  Google Scholar 

  3. American Cancer Society. Detailed guide: multiple myeloma. What are the risk factors for multiple myeloma? Cancer Reference Information [online] (2010).

  4. Kristinsson, S. Y. et al. Patterns of survival and causes of death following a diagnosis of monoclonal gammopathy of undetermined significance: a population-based study. Hematologica 94, 1714–1720 (2009).

    Article  Google Scholar 

  5. Kyle, R. A. & Rajkumar, S. V. Multiple myeloma. Blood 111, 2962–2972 (2008).

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  6. Dimopoulos, M. et al. International myeloma working group consensus statement and guidelines regarding the current role of imaging techniques in the diagnosis and monitoring of multiple myeloma. Leukemia 23, 1545–1556 (2009).

    Article  CAS  PubMed  Google Scholar 

  7. Ludwig, H. et al. Current multiple myeloma treatment strategies with novel agents: a European perspective. Oncologist 15, 6–25 (2010).

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  8. Eriksson, T. et al. Pharmacokinetics of thalidomide in patients with impaired renal function and while on and off dialysis. J. Pharm. Pharmacol. 55, 1701–1706 (2003).

    Article  CAS  PubMed  Google Scholar 

  9. Terpos, E., Roussou, M. & Dimopoulos, M. A. Bortezomib in multiple myeloma. Expert Opin. Drug Metab. Toxicol. 4, 639–654 (2008).

    Article  CAS  PubMed  Google Scholar 

  10. Chen, N. et al. Pharmacokinetics of lenalidomide in subjects with various degrees of renal impairment and in subjects on hemodialysis. J. Clin. Pharmacol. 47, 1466–1475 (2007).

    Article  CAS  PubMed  Google Scholar 

  11. Oakervee, H. E. et al. PAD combination therapy (PS-341/bortezomib, doxorubicin and dexamethasone) for previously untreated patients with multiple myeloma. Br. J. Hematol. 129, 755–762 (2005).

    Article  CAS  Google Scholar 

  12. Sterz, J. et al. The potential of proteasome inhibitors in cancer therapy. Expert Opin. Investig. Drugs 17, 879–895 (2008).

    Article  CAS  PubMed  Google Scholar 

  13. Kastritis, E. et al. Reversibility of renal failure in newly diagnosed multiple myeloma patients treated with high dose dexamethasone-containing regimens and the impact of novel agents. Hematologica 9 2, 546–549 (2007).

    Article  Google Scholar 

  14. Ludwig, H. et al. Bortezomib-doxorubicin-dexamethasone (BDD) in patients with acute light chain induced renal failure (ARF) in multiple myeloma (MM). Final results of a phase II study [abstract 3862]. Blood 114, 1486a (2009).

  15. Weber, D. et al. Lenalidomide plus high-dose dexamethasone provides improved overall survival compared to high-dose dexamethasone alone for relapsed or refractory multiple myeloma (MM): results of 2 phase III studies (MM-009, MM-010) and subgroup analysis of patients with impaired renal function [abstract 3547]. Blood 108, 1012a (2006).

    Google Scholar 

  16. Weber, D. M. et al. The efficacy and safety of lenalidomide plus dexamethasone in relapsed or refractory multiple myeloma patients with impaired renal function [abstract 8542]. J. Clin. Oncol. 26 (Suppl.), 464s (2008).

    Google Scholar 

  17. Reece, D. E. et al. Use of lenalidomide (Revlimid®) ± corticosteroids in relapsed/refractory multiple myeloma patients with elevated baseline serum creatinine levels [abstract 3548]. Blood 108, 1013a (2006).

    Article  Google Scholar 

  18. Weber, D. M. et al. Lenalidomide plus dexamethasone for relapsed multiple myeloma in North America. N. Engl. J. Med. 357, 2133–2142 (2007).

    Article  CAS  PubMed  Google Scholar 

  19. Dimopoulos, M. et al. Lenalidomide plus dexamethasone for relapsed or refractory multiple myeloma. N. Engl. J. Med. 357, 2123–2132 (2007).

    Article  CAS  PubMed  Google Scholar 

  20. Niesvizky, R. et al. Lenalidomide-induced myelosuppression is associated with renal dysfunction: adverse events evaluation of treatment-naive patients undergoing front-line lenalidomide and dexamethasone therapy. Br. J. Hematol. 138, 640–643 (2007).

    Article  CAS  Google Scholar 

  21. Dimopoulos, M. A., Kastritis, E., Rosinol, L., Bladé, J. & Ludwig, H. Pathogenesis and treatment of renal failure in multiple myeloma. Leukemia 22, 1485–1493 (2008).

    Article  CAS  PubMed  Google Scholar 

  22. Palumbo, A. et al. Lenalidomide in combination with dexamethasone for the treatment of relapsed or refractory multiple myeloma. Blood Rev. 23, 87–93 (2009).

    Article  CAS  PubMed  Google Scholar 

  23. Rajkumar, S. V. et al. High-dose dexamethasone versus lenalidomide plus low-dose dexamethasone as initial therapy for newly diagnosed multiple myeloma: an open-label randomised controlled trial. Lancet Oncol. 11, 29–37 (2010).

    Article  CAS  PubMed  Google Scholar 

  24. Rayner, H. C., Haynes, A. P., Thompson, J. R., Russell, N. & Fletcher, J. Perspectives in multiple myeloma: survival, prognostic factors and disease complications in a single center between 1975 and 1988. Q. J. Med. 79, 517–525 (1991).

    CAS  PubMed  Google Scholar 

  25. Kumar, S. et al. Impact of lenalidomide therapy on stem cell mobilization and engraftment post-peripheral blood stem cell transplantation in patients with newly diagnosed myeloma. Leukemia 21, 2035–2042 (2007).

    Article  CAS  PubMed  Google Scholar 

  26. Popat, U. et al. Impairment of filgrastim-induced stem cell mobilization after prior lenalidomide in patients with multiple myeloma. Biol. Blood Marrow Transplant. 15, 718–723 (2009).

    Article  PubMed  PubMed Central  Google Scholar 

  27. Kumar, S. et al. International Myeloma Working Group. Mobilization in myeloma revisited: IMWG consensus perspectives on stem cell collection following initial therapy with thalidomide-, lenalidomide-, or bortezomib-containing regimens. Blood 114, 1729–1735 (2009).

    Article  CAS  PubMed  Google Scholar 

  28. Mark, T. et al. Stem cell mobilization with cyclophosphamide overcomes the suppressive effect of lenalidomide therapy on stem cell collection in multiple myeloma. Biol. Blood Marrow Transplant. 14, 795–798 (2008).

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  29. Giralt, S. et al. International myeloma working group (IMWG) consensus statement and guidelines regarding the current status of stem cell collection and high-dose therapy for multiple myeloma and the role of plerixafor (AMD 3100). Leukemia 2 3, 1904–1912 (2009).

    Article  Google Scholar 

  30. Palumbo, A. et al. A phase III study to determine the efficacy and safety of lenalidomide in combination with melphalan and prednisone (MPR) in elderly patients with newly diagnosed multiple myeloma [abstract 613]. Blood 114, a253 (2009).

    Google Scholar 

Download references

Acknowledgements

Written consent for publication was obtained from the patient. Charles P. Vega, University of California, Irvine, CA, is the author of and is solely responsible for the content of the learning objectives, questions and answers of the MedscapeCME-accredited continuing medical education activity associated with this article.

Author information

Authors and Affiliations

  1. Department of Medicine I, Center of Oncology and Hematology, Wilhelminenspital, Montleartstrasse 37, Vienna, 1160, Austria

    Heinz Ludwig & Niklas Zojer

Authors
  1. Heinz Ludwig
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Niklas Zojer
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Heinz Ludwig.

Ethics declarations

Competing interests

H. Ludwig declares associations with the following companies: Celgene and Ortho-Biotech. N. Zojer declares no competing interests.

Supplementary information

Supplementary Information

Supplementary Information (DOC 41 kb)

Rights and permissions

Reprints and permissions

About this article

Cite this article

Ludwig, H., Zojer, N. Renal recovery with lenalidomide in a patient with bortezomib-resistant multiple myeloma. Nat Rev Clin Oncol 7, 289–294 (2010). https://doi.org/10.1038/nrclinonc.2010.31

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1038/nrclinonc.2010.31

This article is cited by

Search

Advanced search

Quick links

Nature Briefing

Sign up for the Nature Briefing newsletter — what matters in science, free to your inbox daily.

Get the most important science stories of the day, free in your inbox. Sign up for Nature Briefing