[TerryH]

Revlimid, Pomalyst, thalidomide: neurologic side effects

by TerryH on Mon Apr 13, 2015 12:28 pm

I thought I would pass along information about a new study that was just published since it might be useful to know about for anyone taking Revlimid, Pomalyst, or thalidomide – drugs which are known as "immunomodulatory agents".

The study is based on a review of more of the records for than 500 multiple myeloma patients who were treated with either Revlimid, Pomalyst, or thalidomide at a single cancer center (Hershey Medical Center in Pennsylvania).

Among those patients, the authors found 6 cases of patients who developed rather severe, but fortunately reversible, neurologic side effects such as amnesia, the inability to speak, and even a coma. These are not cases of peripheral nervous system problems, such as neuropathy in the hands and feet. Instead, these are cases where the brain was affected by the drug.

This is not normally expected because most cancer drugs are not believed to be able to cross what is known as the blood-brain barrier – a defense system the body has that prevents a lot of things, including most drugs, from getting into the area around the brain.

However, the authors mention that there is some evidence that drugs like Revlimid, Pomalyst, and thalidomide can cross the blood-brain barrier and enter the cerebrospinal fluid (CSF).

Obviously, given the fact that just 6 cases of these side effects occurred out of a total of more than 500 patients who were treated with one of the three drugs, the side effects do not happen often. Still, given how often these drugs are used in myeloma patients, I thought it might be helpful to everyone here to know about the study, on the odd chance that you, or someone you know who has myeloma, develops side effects similar to those discussed in the study.

Study:

UH Patel et al, "Central Neurotoxicity of Immunomodulatory Drugs in Multiple Myeloma," Hematology Reports, Feb 24, 2015 (link to full text of article at Pubmed)

Abstract:

Immunomodulatory drugs (IMiDs) currently used in the treatment of multiple myeloma, are thalidomide, lenalidomide and pomalidomide. One of the most common side effects of thalidomide is neurotoxicity, predominantly in the form of peripheral neuropathy. We report 6 cases of significant central neurotoxicity associated with IMiD therapy. Treat­ment with thalido­mide (1 patient), lenalidomide (4 patients), and pomalidomide (1 patient) was associ­ated with various clinical manifestations of central neuro­toxicity, in­clud­ing reversible coma, amnesia, expressive aphasia, and dysarthria. Central neuro­toxicity should be recog­nized as an important side effect of IMiD therapy.