[OlgaMM]

Eye inflammations during Revlimid maintenance

by OlgaMM on Thu Jan 05, 2017 12:33 pm

Hello.

I was diagnosed with smoldering multiple myeloma in 2008 and progressed to active (symp­tomatic) multiple myeloma in 2015. My induction therapy started at the end of May 2015 and consisted of 3 cycles of Kyprolis with dex followed by 1 cycle of BiRD – Biaxin (clarithromycin), Revlimid, and dexamethasone.

I have been in remission since October 2015, taking 10 mg Revlimid 3 weeks on, 1 week off. In November 2015, my left eye developed iritis, which is an inflammation of the iris (the colored area directly around the pupil). Iritis also is known as anterior uveitis.

All tests for the usual causes of iritis were negative. Exactly one year later, I developed iritis in my right eye developed. Both the first and second time that I developed iritis, I was suc­cess­fully treated with prednisolone eye drops.

In addition to iritis, I was diagnosed with blepharitis in May 2016. As I am allergic to both erythromycin and bacitracin, my treatment consists of of warm compresses and lid scrubs. The blepharitis has not responded. I have also had 2 styes in the past year, something which I cannot recall having in decades.

Has anyone had any experience with iritis? Can iritis be caused by multiple myeloma itself? Can it be caused by Revlimid? As for the blepharitis, I have read on this site that Kyprolis can been associated with blepharitis, but I have not taken Kyprolis since August 2015 – see, for example, the forum discussion "Kyprolis and blepharitis (eye inflammations)" started May 24, 2016.

Any feedback would be greatly appreciated.

Olga

[TerryH]

Re: Eye inflammations during Revlimid maintenance

by TerryH on Thu Jan 05, 2017 6:04 pm

Hi Olga,

Sorry to hear about the eye inflammations you've been experiencing.

As you've already mentioned, there have been other reports of eye-related inflammations / infections here in the forum. There's even one specifically about iritis (anterior uveitis):

https://myelomabeacon.org/forum/eye-inflammation-anterior-uveitis-velcade-t6545.html

Most reports seem to focus on either Velcade or Kyprolis being the cause, but in your case it's Revlimid. This makes me wonder if this sort of thing is

I wonder if the inflammations are due to the immune system being compromised in people with multiple myeloma, particularly when they are undergoing treatment.

I checked to see if there are any published reports about a possible connection between Revlimid and eye inflammations, but I couldn't find any. The clinical trial data in the Revlimid prescribing information also doesn't suggest any connection.

Have any of your white blood cell counts been on the low end, or below the lower normal limit, during your maintenance therapy?

In any case, good luck, and keep us posted.

[Dr. Prashant Kapoor]

Re: Eye inflammations during Revlimid maintenance

by Dr. Prashant Kapoor on Fri Jan 06, 2017 1:03 pm

There are a number of etiologies (causes) for uveitis, including a host of infectious diseases, connective tissue disorders (including sarcoidosis), and drugs. In approximately 30 percent of patients, no etiology is apparent, and the condition is called idiopathic uveitis. There have been rare reports of its association with myeloma.

I am not aware of any association with Revlimid (lenalidomide) use, although intravenous bisphosphonates, such as Zometa (zoledronic acid) and Aredia (pamidronate), have been implicated.