I now the topic of maintenance therapy is a popular one here. I saw a study on PubMed that was just published that may interest those making that decision. The two sentence conclusion is as follows:
"Lenalidomide impaired long-term thymic T-cell reconstitution, decreased CD4+ and CD8+ CD45RA+CCR7- effector-terminal T-cell absolute counts and increased CD4+CD25+CD127-/low regulatory T-cells. Lenalidomide consolidation and long-term maintenance therapy, administered post-ASCT, may have a potentially negative impact on immune surveillance."
http://www.ncbi.nlm.nih.gov/pubmed/24237448
The first couple paragraphs of this paper describe what thymic t cells are.
"The thymus is a small, inconspicuous organ, but it is also vital for a functional immune system. This is because it is the development site of the T-lymphocytes (T-cells), which play a central role in the body's immune defences. Their precursors come from the bone marrow and are lured into the thymus by chemical attractants called chemokines. Once in the thymus, they develop into different T-cell types, which are eventually deployed into the rest of the body."
http://www.sciencedaily.com/releases/2012/02/120217145621.htm
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Re: Revlimid (lenalidomide) maintenance
Indeed something to consider. Thanks Mark.
If you are like me, you may not have known what "immune surveillance" is. This gives you a basic intro to the theory:
http://users.rcn.com/jkimball.ma.ultranet/BiologyPages/I/ImmSurveillance.html
If you are like me, you may not have known what "immune surveillance" is. This gives you a basic intro to the theory:
http://users.rcn.com/jkimball.ma.ultranet/BiologyPages/I/ImmSurveillance.html
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Multibilly - Name: Multibilly
- Who do you know with myeloma?: Me
- When were you/they diagnosed?: Smoldering, Nov, 2012
Re: Revlimid (lenalidomide) maintenance
I just started my second year of Revlimid maintenance....wish I hadn't read this...lol. 
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terryl1 - Name: Terry
- Who do you know with myeloma?: self
- When were you/they diagnosed?: August 10, 2011
- Age at diagnosis: 49
Re: Revlimid (lenalidomide) maintenance
Having a reduced count of CD4+ cells long term is definitely a serious side effect. To give you an idea how important theses cells are, here is a quick description of what AIDS is:
"A CD4+ count is a blood test to determine how well the immune system is working in people who have been diagnosed with human immunodeficiency virus (HIV). CD4+ cells are a type of white blood cell. White blood cells are important in fighting infections. CD4+ cells are also called T-lymphocytes, T-cells, or T-helper cells.
HIV infects CD4+ cells. The number of CD4+ cells helps determine whether other infections (opportunistic infections) may occur. The pattern of CD4+ counts over time is more important than any single CD4+ value because the values can change from day to day. The CD4+ pattern over time shows the effect of the virus on the immune system. In people infected with HIV who are not getting treated, CD4+ counts generally decrease as HIV progresses. A low CD4+ count usually indicates a weakened immune system and a higher chance of getting opportunistic infections."
http://www.webmd.com/hiv-aids/cd4-count
"How HIV Affects CD4 Cells
HIV targets CD4 cells by:
Binding to the surface of CD4 cells
Entering CD4 cells and becoming a part of them. As CD4 cells multiply to fight infection, they also make more copies of HIV
Continuing to replicate, leading to a gradual decline of CD4 cells
HIV can destroy entire "families" of CD4 cells. Then the diseases these "families" were designed to fight can easily take over. That's when opportunistic infections are likely to develop."
http://www.webmd.com/hiv-aids/cd4-count-what-does-it-mean
"A CD4+ count is a blood test to determine how well the immune system is working in people who have been diagnosed with human immunodeficiency virus (HIV). CD4+ cells are a type of white blood cell. White blood cells are important in fighting infections. CD4+ cells are also called T-lymphocytes, T-cells, or T-helper cells.
HIV infects CD4+ cells. The number of CD4+ cells helps determine whether other infections (opportunistic infections) may occur. The pattern of CD4+ counts over time is more important than any single CD4+ value because the values can change from day to day. The CD4+ pattern over time shows the effect of the virus on the immune system. In people infected with HIV who are not getting treated, CD4+ counts generally decrease as HIV progresses. A low CD4+ count usually indicates a weakened immune system and a higher chance of getting opportunistic infections."
http://www.webmd.com/hiv-aids/cd4-count
"How HIV Affects CD4 Cells
HIV targets CD4 cells by:
Binding to the surface of CD4 cells
Entering CD4 cells and becoming a part of them. As CD4 cells multiply to fight infection, they also make more copies of HIV
Continuing to replicate, leading to a gradual decline of CD4 cells
HIV can destroy entire "families" of CD4 cells. Then the diseases these "families" were designed to fight can easily take over. That's when opportunistic infections are likely to develop."
http://www.webmd.com/hiv-aids/cd4-count-what-does-it-mean
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Mark
Re: Revlimid (lenalidomide) maintenance
Dear mark,
Thank you so much for your post, to make it more simple, Lenalidomide maintenance, will eventually destroy the immune system? this is serious.. thank you so much!
Thank you so much for your post, to make it more simple, Lenalidomide maintenance, will eventually destroy the immune system? this is serious.. thank you so much!
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Blanca n - Name: Blanca N
- Who do you know with myeloma?: My husband
- When were you/they diagnosed?: June 13 2013
- Age at diagnosis: 50
Re: Revlimid (lenalidomide) maintenance
Just noticed this abstract on PubMed. It discusses a small chance of autoimmune diseases occurring while patients are using lenalidomide. I know this issue of lenalidomide maintenance is often discussed here so I thought it may be helpful info for patients to have.
Immunomodulatory drugs (IMiDs) may favour autoimmune diseases (ADs) occurrence. We conducted a retrospective study to evaluate ADs occurrence among IMIDs-treated myeloma patients. Patients were grouped into three classes depending on the type of IMID used. The first group included patients treated with thalidomide (thalidomide) (n=474), the second group with lenalidomide (Len) (n=140), while patients in the third group were first treated with thalidomide followed by Len (Thal-Len) (n= 94). Absolute risk of AD was 0.4% for patients treated with thalidomide, 4.3% for Len, and 1.1% for Thal-Len group. ADs manifested prevalently as autoimmune cytopenias (55%), although we observed one vasculitis, one optic neuritis, one Grave's disease, and one polymiositis. ADs occurred preferentially in the first months of IMiD treatment. A previous autologous transplant was shown to be a significant risk factor. All ADs were managed with IMiD discontinuation and steroids, resolving in few weeks, except for Grave's disease and polymiositis.
http://www.ncbi.nlm.nih.gov/pubmed/24730540
Immunomodulatory drugs (IMiDs) may favour autoimmune diseases (ADs) occurrence. We conducted a retrospective study to evaluate ADs occurrence among IMIDs-treated myeloma patients. Patients were grouped into three classes depending on the type of IMID used. The first group included patients treated with thalidomide (thalidomide) (n=474), the second group with lenalidomide (Len) (n=140), while patients in the third group were first treated with thalidomide followed by Len (Thal-Len) (n= 94). Absolute risk of AD was 0.4% for patients treated with thalidomide, 4.3% for Len, and 1.1% for Thal-Len group. ADs manifested prevalently as autoimmune cytopenias (55%), although we observed one vasculitis, one optic neuritis, one Grave's disease, and one polymiositis. ADs occurred preferentially in the first months of IMiD treatment. A previous autologous transplant was shown to be a significant risk factor. All ADs were managed with IMiD discontinuation and steroids, resolving in few weeks, except for Grave's disease and polymiositis.
http://www.ncbi.nlm.nih.gov/pubmed/24730540
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Mark
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