Moore Christine A, Ibrahim Moayed, Kapila Aaysha, Bajaj Kailash
Internist at East Tennessee State University in Kingsport.
Internist at East Tennessee State University in Johnson City.
Perm J. 2018;22:17-125. doi: 10.7812/TPP/17-125.
Lenalidomide is an immunomodulatory drug approved by the US Food and Drug Administration in 2006 for the treatment of multiple myeloma. In 2012, the Food and Drug Administration issued a statement warning physicians of the increased risk with lenalidomide treatment of the following secondary primary malignancies: Acute myelogenous leukemia, myelodysplastic syndromes, and Hodgkin lymphoma. The statement did not mention glioblastoma multiforme, a Grade 4 astrocytoma, or other high-grade astrocytomas that have been reported on rare occasions in the setting of multiple myeloma.
A 72-year-old man, who had been in complete remission from multiple myeloma for 1 year after treatment that included lenalidomide, presented with confusion, headache, nausea and vomiting, and recurrent falls. A magnetic resonance image of his brain revealed a mass that on stereotactic biopsy was found to be glioblastoma multiforme.
We present the seventh reported case of high-grade astrocytoma as a second primary malignancy in multiple myeloma and the first reported occurrence of glioblastoma multiforme after the use of lenalidomide in multiple myeloma. This report adds to the pool of cases that reveal associations between use of lenalidomide and increased risk of developing secondary primary high-grade astrocytomas in multiple myeloma.
来那度胺是一种免疫调节药物，于2006年被美国食品药品监督管理局批准用于治疗多发性骨髓瘤。2012年，食品药品监督管理局发布声明，警告医生来那度胺治疗会增加以下继发性原发性恶性肿瘤的风险：急性髓系白血病、骨髓增生异常综合征和霍奇金淋巴瘤。该声明未提及多形性胶质母细胞瘤（一种4级星形细胞瘤）或其他在多发性骨髓瘤患者中偶尔报告的高级别星形细胞瘤。
一名72岁男性，在接受包括来那度胺在内的治疗后，多发性骨髓瘤已完全缓解1年，出现意识模糊、头痛、恶心呕吐及反复跌倒。其脑部磁共振成像显示有一个肿块，立体定向活检发现为多形性胶质母细胞瘤。
我们报告了第七例高级别星形细胞瘤作为多发性骨髓瘤继发性原发性恶性肿瘤的病例，也是首例在多发性骨髓瘤中使用来那度胺后发生多形性胶质母细胞瘤的病例。本报告增加了揭示来那度胺使用与多发性骨髓瘤患者发生继发性原发性高级别星形细胞瘤风险增加之间关联的病例数量。
