How it is administered

Lenalidomide is taken by mouth as a capsule. It is available in several strengths, including 2.5 mg, 5 mg, 10 mg, 15 mg, 20 mg, and 25 mg capsules. The capsules should be swallowed whole with water, and should not be opened, broken, or chewed. Lenalidomide can be taken with or without food, at about the same time each day.

How it works

Lenalidomide is a medicine that modifies the immune system and has anti-cancer properties. It is a thalidomide analogue, meaning it is chemically related to thalidomide but designed to be more effective and safer. Lenalidomide works by targeting a protein called cereblon, which is part of a complex that helps regulate the breakdown of certain proteins in cells. When lenalidomide binds to cereblon, it causes the destruction of specific proteins that are important for the survival of abnormal blood cells.

In myelodysplastic syndromes (MDS) with a deletion 5q abnormality, lenalidomide helps reduce the need for blood transfusions by improving the production of healthy blood cells. It also helps the immune system recognize and attack abnormal cells, and reduces the production of substances that promote inflammation and cancer cell growth. Lenalidomide can also block the growth of new blood vessels that tumors need to grow (antiangiogenic effect).

Who Should take it

Lenalidomide is approved for adults with transfusion-dependent anemia due to low- or intermediate-1-risk myelodysplastic syndromes (MDS) associated with a deletion 5q cytogenetic abnormality, with or without additional cytogenetic abnormalities. This means it is especially helpful for people with MDS who need frequent blood transfusions and have a specific genetic change in their bone marrow cells.

It is also used for other blood cancers, such as multiple myeloma (in combination with dexamethasone), as maintenance therapy after stem cell transplant in multiple myeloma, and for some types of lymphoma. In MDS, the goal is to reduce the need for transfusions and improve blood counts.

Who should not take it

Lenalidomide should not be taken by women who are pregnant, as it can cause severe birth defects or death to an unborn baby. Women of childbearing potential must use two forms of birth control and have regular pregnancy tests before, during, and after treatment. Men taking lenalidomide must also use condoms during sexual contact with women who can become pregnant, even if they have had a vasectomy, and must not donate sperm during and for 4 weeks after stopping the medication.

People who have had severe allergic reactions to lenalidomide (such as angioedema, Stevens-Johnson syndrome, or toxic epidermal necrolysis) should not take it. Lenalidomide is also not recommended for patients with chronic lymphocytic leukemia (CLL) outside of clinical trials.

Commonly used with

In MDS, lenalidomide is usually used alone. In other blood cancers, such as multiple myeloma, it is commonly used with dexamethasone (a steroid). In some lymphomas, it may be used in combination with rituximab (an antibody therapy). Your doctor will decide if any additional medications are needed based on your specific diagnosis.

Commonly tested with

Lenalidomide has been tested in combination with dexamethasone for multiple myeloma, and with rituximab for certain types of lymphoma. In MDS, it is generally studied as a single agent, especially in patients with the 5q deletion. It is not recommended to be combined with certain immune checkpoint inhibitors (like pembrolizumab) in multiple myeloma due to increased risk of death.