Lenalidomide

How it works

It is a thalidomide analogue that modulates the immune system and the tumour microenvironment, exerting antineoplastic, antiangiogenic and pro-erythropoietic effects.

Prescribing in practice

• It is teratogenic and must be prescribed under a pregnancy prevention programme with strict contraception and pregnancy testing for those of childbearing potential.
• It markedly increases venous and arterial thromboembolism risk, so appropriate thromboprophylaxis should be considered.
• Myelosuppression, particularly neutropenia and thrombocytopenia, is common and requires regular monitoring and dose adjustment.

Monitoring

Monitor full blood count regularly for cytopenias and remain alert to thromboembolism, while adhering to pregnancy-prevention testing requirements.

Counselling the patient

• Use the required contraception and complete pregnancy tests; never share this medicine with anyone.
• Report leg swelling or pain, chest pain or breathlessness, which may indicate a clot.
• Report fever, bruising or bleeding and attend your blood tests.

Evidence & guidelines

Lenalidomide is recommended by NICE across several haematological indications, supported by randomised trials in multiple myeloma and del(5q) myelodysplastic syndrome.