Pharmacokinetics of lenalidomide during high cut-off dialysis in a patient with multiple myeloma and renal failure

Cancer Chemother Pharmacol. 2017 Jan;79(1):215-218. doi: 10.1007/s00280-016-3219-z. Epub 2016 Dec 17.


Introduction: High cut-off dialysis, increasingly used in multiple myeloma patients, is susceptible to influence anticancer drug elimination. We report about lenalidomide disposition in a patient on high cut-off dialysis for renal failure secondary to myeloma cast nephropathy.

Methods: The patient received a higher dosage of lenalidomide (5 mg b.i.d.), owing to concerns about a potential decrease in lenalidomide exposure during dialysis sessions. A set of blood samples was taken in order to develop a pharmacokinetic model accounting for lenalidomide concentrations in this setting.

Results: According to our model, the area under the curve was 3273 µg h/L, i.e., 60% higher than expected under usual dosage (25 mg q.d.) with normal renal function. Despite this, the patient did not develop major hematological toxicity.

Conclusions: Lenalidomide doses of 5 mg b.i.d. led to high exposure in a patient with renal failure undergoing high cut-off dialysis. Yet, the dosage of 5 mg q.d. recommended in conventional dialysis would probably be adequate in such patients.

Keywords: High cut-off membrane; High-flux dialysis; Lenalidomide; Pharmacokinetics.

Publication types

  • Case Reports

MeSH terms

  • Aged
  • Angiogenesis Inhibitors / pharmacokinetics*
  • Female
  • Humans
  • Kidney Failure, Chronic / therapy*
  • Lenalidomide
  • Multiple Myeloma / drug therapy*
  • Renal Dialysis*
  • Thalidomide / analogs & derivatives*
  • Thalidomide / pharmacokinetics


  • Angiogenesis Inhibitors
  • Thalidomide
  • Lenalidomide