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. The capsules should be swallowed whole with water, and should not be opened, broken, or chewed. Lenalidomide can be taken with or without food, and it is usually taken once daily at about the same time each day. If you miss a dose, you may take it up to 12 hours after your usual time; if more than 12 hours have passed, skip the dose and take your next dose at the usual time. Do not take two doses at once.

How it works

Lenalidomide is an immunomodulatory medication, which means it helps regulate the immune system. It is a thalidomide analogue with antiangiogenic (prevents the growth of new blood vessels that tumors need to grow) and antineoplastic (anti-cancer) properties. Lenalidomide works by targeting a protein called cereblon, which is part of a complex that tags certain proteins for destruction within cells. By causing the breakdown of specific proteins involved in cancer cell survival, lenalidomide can stop the growth of cancer cells and trigger their death.

Additionally, lenalidomide boosts the activity of immune cells, such as T cells and natural killer (NK) cells, which can help the body attack cancer cells more effectively. It also reduces the production of certain substances (cytokines) that promote inflammation and cancer cell growth. In blood cancers, including multiple myeloma and some lymphomas, lenalidomide has been shown to slow disease progression and improve survival when used alone or in combination with other treatments.

Who Should take it

Lenalidomide is used to treat several blood cancers. For myelofibrosis, there is limited direct evidence, but lenalidomide is sometimes considered in clinical practice for certain patients, especially those with anemia. Its main FDA-approved uses include:

• Multiple myeloma: In combination with dexamethasone, or as maintenance therapy after stem cell transplant.
• Myelodysplastic syndromes (MDS): For patients with transfusion-dependent anemia due to low- or intermediate-1-risk MDS with a specific chromosome abnormality (deletion 5q).
• Mantle cell lymphoma: For patients whose disease has relapsed or progressed after at least two prior therapies, including bortezomib.
• Follicular lymphoma and marginal zone lymphoma: In combination with rituximab for previously treated patients.

Your doctor will decide if lenalidomide is appropriate for you based on your diagnosis, previous treatments, and overall health.

Who should not take it

Lenalidomide should NOT be taken by:

• Women who are pregnant or may become pregnant, as it can cause severe birth defects or death of an unborn baby. Strict pregnancy prevention measures are required.
• Patients who have had severe allergic reactions to lenalidomide (such as angioedema, Stevens-Johnson syndrome, or toxic epidermal necrolysis).

Caution is also needed in people with severe kidney problems, liver problems, or a history of blood clots. Lenalidomide is not recommended for use in children, and it is not indicated for chronic lymphocytic leukemia outside of clinical trials due to increased risk of death. Always discuss your full medical history with your doctor before starting lenalidomide.

Commonly used with

Lenalidomide is commonly used with:

• Dexamethasone (a steroid) for multiple myeloma
• Rituximab (an antibody therapy) for follicular and marginal zone lymphoma

It may also be used after stem cell transplantation as maintenance therapy. Sometimes, other supportive medications are used to reduce the risk of blood clots or infections.

Commonly tested with

Lenalidomide has been tested in combination with:

• Dexamethasone (for multiple myeloma)
• Rituximab (for lymphomas)
• Bortezomib and other chemotherapy agents

It has also been studied with other immune therapies and targeted agents in clinical trials for various blood cancers. Your doctor will determine the best combination based on your specific condition and treatment goals.