Outcomes and management of lenalidomide-associated rash in patients with multiple myeloma

Leuk Lymphoma. 2016 Nov;57(11):2510-5. doi: 10.3109/10428194.2016.1151507. Epub 2016 Mar 4.


The immunomodulatory drugs thalidomide, lenalidomide, and pomalidomide (IMiDs) are an important component of myeloma treatment; one of six available drug classes for this incurable disease. Rash is a frequent side effect of IMiDs, particularly lenalidomide, often leading to treatment discontinuation. We retrospectively reviewed 52 patients (7.2% of patients seen during that time) with IMiD associated at a median of 3 weeks after exposure. Nearly all rashes were morbilliform, and 45% of evaluable rashes were grade 3-4 by NCI-CTCAE criteria. IMiDs were initially held in 33 patients (62%), and 25% received a short course of higher dose steroids. Seventy-nine percent of patients were reexposed to the same IMiD, often with dose reduction, and 57% were switched from weekly dexamethasone to thrice-weekly prednisone. Ninety-three percent of patients reexposed to the same IMiD with these interventions were able to tolerate and continue treatment, and only 14% had rash with reexposure, predominantly grade 1-2.

Keywords: Lenalidomide; myeloma; pomalidomide; rash; thalidomide.

MeSH terms

  • Adrenal Cortex Hormones / therapeutic use
  • Adult
  • Aged
  • Aged, 80 and over
  • Disease Management
  • Exanthema / diagnosis
  • Exanthema / etiology*
  • Exanthema / therapy*
  • Female
  • Humans
  • Immunologic Factors / adverse effects*
  • Immunologic Factors / therapeutic use
  • Lenalidomide
  • Male
  • Middle Aged
  • Multiple Myeloma / complications*
  • Multiple Myeloma / diagnosis
  • Multiple Myeloma / drug therapy
  • Retrospective Studies
  • Severity of Illness Index
  • Thalidomide / adverse effects
  • Thalidomide / analogs & derivatives*
  • Thalidomide / therapeutic use
  • Treatment Outcome


  • Adrenal Cortex Hormones
  • Immunologic Factors
  • Thalidomide
  • Lenalidomide