Tohoku J. Exp. Med., 2023 February, 259(2)

Suspected Immune Thrombocytopenic Purpura Induced by Lenalidomide for the Treatment of Myelodysplastic Syndrome with Deletion of Chromosome 5q: A Case Report

Haruna Furukawa,¹ Jun Nomura,¹ Masahiro Kobayashi,¹ Shori Abe,¹ Tomoki Takeda,¹ Yumiko Oka,¹ Yuko Shirota,¹ Takao Kodera,¹ Yoko Okitsu,² Shinichiro Takahashi,² Keigo Murakami³ and Junichi Kameoka¹

¹Division of Hematology and Rheumatology, Tohoku Medical and Pharmaceutical University Hospital, Sendai, Miyagi, Japan
²Department of Clinical Laboratory, Tohoku Medical and Pharmaceutical University Hospital, Sendai, Miyagi, Japan
³Division of Pathology, Tohoku Medical and Pharmaceutical University Hospital, Sendai, Miyagi, Japan

Lenalidomide (LEN), one of the key drugs in the treatment of myelodysplastic syndromes (MDS) with 5q deletion, as well as multiple myeloma (MM), has various immunomodulatory effects and has been associated with autoimmune diseases, including immune thrombocytopenic purpura (ITP). A 78-year-old man presented with pancytopenia and was diagnosed with MDS with 5q deletion and other chromosomal abnormalities. Two cycles of LEN therapy (one cycle: 10 mg/day for 21 days) resulted in a transient improvement in anemia, followed by MDS progression with severe thrombocytopenia (4 × 10⁹/L) refractory to platelet transfusions. As other non-immune and alloimmune causes of transfusion-refractory thrombocytopenia were excluded, and the level of platelet-associated immunoglobulin G was extremely high compared with the level before treatment with LEN, the diagnosis of ITP was highly suspected. Despite treatment with prednisolone (PSL), eltrombopag, and repeated platelet transfusions, his platelet count did not increase, and he died of a gastrointestinal hemorrhage. Several cases of ITP induced by LEN used to treat MM had been reported, but the platelet count recovered after administration of PSL in these previous cases. However, we should be mindful of using LEN for patients with MDS because its treatment may become extremely difficult if ITP develops.

Keywords —— 5q− syndrome; immune thrombocytopenic purpura; lenalidomide; myelodysplastic syndrome

© 2023 Tohoku University Medical Press

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Tohoku J. Exp. Med 2023, 259, 113-119.

Correspondence: Junichi Kameoka, Division of Hematology and Rheumatology, Tohoku Medical and Pharmaceutical University Hospital, 1-15-1 Fukumuro, Miyagino-ku, Sendai, Miyagi 983-8536, Japan.

e-mail: j-kame@tohoku-mpu.ac.jp