I'm currently on Revlimid maintenance and in CR.
Over the last month my EOS # has risen and I don't have any of the usual symtoms that would relate to this rise (allergies, gastric issues etc.).
We are continuing to do tests, however, has anyone else seen these?
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mso - Name: Mic
- Who do you know with myeloma?: self
- When were you/they diagnosed?: Sept 2010
- Age at diagnosis: 53
Re: High eosinophils on Revlimid maintenance
Hi! Sorry for your side effects from the Revlimid. I am also on 10mg daily since my stem cell transplant in Dec.2012. I have not noticed anything to alarming. I am just very sensitive to a lot I thought it was from the transplant. I hope you feel better. I have a low wbc and need to stay on the Revlimid for another 18 months. It is scary but we have to put our faith in God !
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faith
Re: High eosinophils on Revlimid maintenance
Eosinophils are a type of white blood cell that are often involved in allergic-type reactions. They rarely can also be elevated with certain parasitic infections, or with adrenal gland insufficiency. In this case, it likely reflects a mild reaction to the Revlimid (or another drug you might be on). But if they are remaining stable and there are no other signs or symptoms of a drug allergy (e.g. rash, hives, swelling, fevers), then normally we would just continue the drug and monitor closely, as you are doing.
Hope this helps.
Hope this helps.
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Dr. Adam Cohen - Name: Adam D. Cohen, M.D.
Beacon Medical Advisor
Re: High eosinophils on Revlimid maintenance
Hello mso,
I know your post was a long time ago. I was wondering about your high eosinophil count and if there was ever any other significance found. My husband, who had a transplant this past July and is now currently on Revlimid maintenance, recently got a CBC back with high eosinophil count indicating eosinophilia. I have read that eosinophils play a part in allergy reactions and a possible rare response to Revlimid, but I also read an article that suggested that eosinophils are part of a mechanism that makes multiple myeloma plasma cell proliferate. I can't really find any other information. I was wondering how it all turned out for you. The link to the article and article abstract are below.
Hope you are well
Mrswrench
Article:
Wong, TW, et al, "Induction of malignant plasma cell proliferation by eosinophils," PLoS One, Jul 22, 2013 (full text of article)
Abstract:
The biology of the malignant plasma cells (PCs) in multiple myeloma is highly influenced by the bone marrow (BM) microenvironment in which they reside. More specifically, BM stromal cells (SCs) are known to interact with multiple myeloma cells to promote multiple myeloma cell survival and proliferation. By contrast, it is unclear if innate immune cells within this same space also actively participate in the pathology of multiple myeloma. Our study shows for the first time that eosinophils (Eos) can contribute to the biology of multiple myeloma by enhancing the proliferation of some malignant PCs. We first demonstrate that PCs and Eos can be found in close proximity in the BM. In culture, Eos were found to augment multiple myeloma cell proliferation that is predominantly mediated through a soluble factor(s). Fractionation of cell-free supernatants and neutralization studies demonstrated that this activity is independent of Eos-derived microparticles and a proliferation-inducing ligand (APRIL), respectively. Using a multicellular in vitro system designed to resemble the native multiple myeloma niche, SCs and Eos were shown to have non-redundant roles in their support of multiple myeloma cell growth. Whereas SCs induce multiple myeloma cell proliferation predominantly through the secretion of IL-6, Eos stimulate growth of these malignant cells via an IL-6-independent mechanism. Taken together, our study demonstrates for the first time a role for Eos in the pathology of multiple myeloma and suggests that therapeutic strategies targeting these cells may be beneficial.
I know your post was a long time ago. I was wondering about your high eosinophil count and if there was ever any other significance found. My husband, who had a transplant this past July and is now currently on Revlimid maintenance, recently got a CBC back with high eosinophil count indicating eosinophilia. I have read that eosinophils play a part in allergy reactions and a possible rare response to Revlimid, but I also read an article that suggested that eosinophils are part of a mechanism that makes multiple myeloma plasma cell proliferate. I can't really find any other information. I was wondering how it all turned out for you. The link to the article and article abstract are below.
Hope you are well
Mrswrench
Article:
Wong, TW, et al, "Induction of malignant plasma cell proliferation by eosinophils," PLoS One, Jul 22, 2013 (full text of article)
Abstract:
The biology of the malignant plasma cells (PCs) in multiple myeloma is highly influenced by the bone marrow (BM) microenvironment in which they reside. More specifically, BM stromal cells (SCs) are known to interact with multiple myeloma cells to promote multiple myeloma cell survival and proliferation. By contrast, it is unclear if innate immune cells within this same space also actively participate in the pathology of multiple myeloma. Our study shows for the first time that eosinophils (Eos) can contribute to the biology of multiple myeloma by enhancing the proliferation of some malignant PCs. We first demonstrate that PCs and Eos can be found in close proximity in the BM. In culture, Eos were found to augment multiple myeloma cell proliferation that is predominantly mediated through a soluble factor(s). Fractionation of cell-free supernatants and neutralization studies demonstrated that this activity is independent of Eos-derived microparticles and a proliferation-inducing ligand (APRIL), respectively. Using a multicellular in vitro system designed to resemble the native multiple myeloma niche, SCs and Eos were shown to have non-redundant roles in their support of multiple myeloma cell growth. Whereas SCs induce multiple myeloma cell proliferation predominantly through the secretion of IL-6, Eos stimulate growth of these malignant cells via an IL-6-independent mechanism. Taken together, our study demonstrates for the first time a role for Eos in the pathology of multiple myeloma and suggests that therapeutic strategies targeting these cells may be beneficial.
Re: High eosinophils on Revlimid maintenance
MrsWrench.
Thanks for your post 8 months ago and raising the issue of Revlimid and eosinophils.
I was diagnosed this summer with multiple myeloma at age 69 and started Velcade, Revlimid, and dexamethasone (VRd) on 3 week cycles. Within days, my back pain resolved, but I started with mild rash, fatigue, and fainting. I managed to get through the first cycle with adjustment of blood pressure medications, but midway through the second they stopped everything because of abnormal liver functions, total body rash, severe edema of trunk and extremities and eosinophilia. Over a few weeks, symptoms and abnormal laboratory results resolved, and I'm doing well on just Vd, finishing cycle 3. There seems to be a name for this, "DRESS syndrome" (see reference and abstract below), but I wasn't able to find much more about Revlimid and eosinophillia. Hope your hubby is doing well.
WAC
Reference:
Shanbhag, A, et al.,"Highly Probable Drug Reaction With Eosinophilia and Systemic Symptoms Syndrome Associated With Lenalidomide," Hosp Pharm. 2017 Jun;52(6):408-411. doi: 10.1177/0018578717717394. Epub 2017 Jul 18 (abstract; full text at Pubmed Central)
Abstract:
Drug reaction with eosinophilia and systemic symptoms (DRESS) syndrome is a life-threatening hypersensitivity reaction to medications. We report a case of a 75-year-old African American female who presented with generalized rash with desquamation and malodorous secretions. She was febrile and hypotensive, and required vasopressors for hemodynamic instability. Sepsis secondary to skin or soft tissue infection was considered initially. However, she recently was started on lenalidomide for treatment of her multiple myeloma, and her white blood cell count of 17 K/µL with 55% eosinophils along with peripheral smear showing eosinophilia suggested lenalidomide-induced rash. Lenalidomide was discontinued, and methylprednisolone was initiated. Four days after lenalidomide discontinuation, vasopressors were discontinued. Blood cultures did not exhibit any growth. The Niranjo Adverse Drug Reaction Probability Scale score of 9 suggests lenalidomide was a highly probable cause of DRESS syndrome. The temporal relation of lenalidomide administration and development of symptoms plus improvement of rash with the discontinuation of lenalidomide and reappearance on restarting lenalidomide in the follow-up clinic strengthens our suspicion of lenalidomide-induced DRESS syndrome. Cases of lenalidomide-induced DRESS syndrome are sparse; however, DRESS syndrome is fatal in approximately 10% of patients. Providers should be aware and keep a vigilant eye out for this adverse reaction with lenalidomide.
Thanks for your post 8 months ago and raising the issue of Revlimid and eosinophils.
I was diagnosed this summer with multiple myeloma at age 69 and started Velcade, Revlimid, and dexamethasone (VRd) on 3 week cycles. Within days, my back pain resolved, but I started with mild rash, fatigue, and fainting. I managed to get through the first cycle with adjustment of blood pressure medications, but midway through the second they stopped everything because of abnormal liver functions, total body rash, severe edema of trunk and extremities and eosinophilia. Over a few weeks, symptoms and abnormal laboratory results resolved, and I'm doing well on just Vd, finishing cycle 3. There seems to be a name for this, "DRESS syndrome" (see reference and abstract below), but I wasn't able to find much more about Revlimid and eosinophillia. Hope your hubby is doing well.
WAC
Reference:
Shanbhag, A, et al.,"Highly Probable Drug Reaction With Eosinophilia and Systemic Symptoms Syndrome Associated With Lenalidomide," Hosp Pharm. 2017 Jun;52(6):408-411. doi: 10.1177/0018578717717394. Epub 2017 Jul 18 (abstract; full text at Pubmed Central)
Abstract:
Drug reaction with eosinophilia and systemic symptoms (DRESS) syndrome is a life-threatening hypersensitivity reaction to medications. We report a case of a 75-year-old African American female who presented with generalized rash with desquamation and malodorous secretions. She was febrile and hypotensive, and required vasopressors for hemodynamic instability. Sepsis secondary to skin or soft tissue infection was considered initially. However, she recently was started on lenalidomide for treatment of her multiple myeloma, and her white blood cell count of 17 K/µL with 55% eosinophils along with peripheral smear showing eosinophilia suggested lenalidomide-induced rash. Lenalidomide was discontinued, and methylprednisolone was initiated. Four days after lenalidomide discontinuation, vasopressors were discontinued. Blood cultures did not exhibit any growth. The Niranjo Adverse Drug Reaction Probability Scale score of 9 suggests lenalidomide was a highly probable cause of DRESS syndrome. The temporal relation of lenalidomide administration and development of symptoms plus improvement of rash with the discontinuation of lenalidomide and reappearance on restarting lenalidomide in the follow-up clinic strengthens our suspicion of lenalidomide-induced DRESS syndrome. Cases of lenalidomide-induced DRESS syndrome are sparse; however, DRESS syndrome is fatal in approximately 10% of patients. Providers should be aware and keep a vigilant eye out for this adverse reaction with lenalidomide.
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