Lenalidomide
By Alice Chung, MD
Medically Reviewed by Jorge J. García PharmD, MS, MHA, MBA, FACHE
Last Update: January 20, 2025
What is Lenalidomide?
Lenalidomide is a medication commonly used to treat certain blood and bone marrow disorders, including multiple myeloma, myelodysplastic syndromes (MDS), and mantle cell lymphoma. It works by boosting the immune system to fight cancer cells, reducing the growth of abnormal cells, and decreasing inflammation. This drug is often combined with other treatments, such as chemotherapy or corticosteroids, to improve its effectiveness. It is available in capsule form and taken under the guidance of a healthcare provider.
Although this medication offers many benefits for managing specific conditions, it can cause serious side effects, such as a weakened immune system, blood clots, or birth defects if taken during pregnancy. Regular monitoring by a doctor is essential to ensure the safe use of this medication. If you’re prescribed this immunomodulatory agent, following the recommended dosage and discussing any concerns with your healthcare provider can help you manage the treatment effectively.
FAQ
What type of chemotherapy is lenalidomide?
Lenalidomide belongs to a class of drugs known as immunomodulatory agents. Unlike traditional chemotherapy, which directly targets and kills rapidly dividing cancer cells, the drug works by enhancing the immune system’s ability to fight cancer. It also slows the growth of abnormal cells and reduces inflammation, making it an effective treatment for conditions like multiple myeloma, myelodysplastic syndromes (MDS), and mantle cell lymphoma. Its unique action classifies it as a targeted therapy rather than conventional chemotherapy.
While this thalidomide analog is part of cancer treatment, it comes with specific side effects that require careful management, such as a higher risk of infection, blood clots, or fatigue. It is taken orally in capsule form, usually in combination with other therapies, such as steroids or traditional chemotherapy.
How does it work?
Lenalidomide’s mechanism of action involves boosting the immune system and targeting abnormal cells to slow their growth. It stimulates immune cells like T cells and natural killer cells to attack cancer cells more effectively. Additionally, the drug reduces blood vessel formation (angiogenesis) that tumors need to grow, helping to shrink or stop the spread of the disease. This dual action makes it a powerful treatment for conditions like multiple myeloma and myelodysplastic syndromes (MDS).
This medication also modifies the environment around cancer cells, limiting their ability to survive and multiply. By influencing certain proteins and pathways, it works differently than traditional chemotherapy, focusing more on immune regulation and targeted effects.
How much does lenalidomide cost?
The cost of this medication can vary depending on the dosage and location, but the brand-name version typically ranges from $15,000 to $20,000 per month in many countries. This high price reflects the specialized nature of the medication and its role in treating complex conditions like multiple myeloma and myelodysplastic syndromes (MDS). However, insurance coverage or assistance programs may help reduce the out-of-pocket expense for eligible patients.
You can save significantly by choosing the generic version of Lenalidomide, which is much more affordable and offers the same effectiveness as the brand-name drug. Generic options may cost a fraction of the price, often starting at $2,000 to $6,000 per month or even less, depending on the supplier and your location.
What foods should you avoid when taking these pills?
When taking Lenalidomide, it’s important to follow dietary warnings to ensure the medication works effectively and to minimize side effects. Although there are no strict bans, certain foods and drinks should be avoided or limited for optimal results.
Foods and drinks to avoid or limit:
- Grapefruit and grapefruit juice (interferes with medication metabolism).
- Alcohol (worsens fatigue and may strain the liver).
- Raw or undercooked foods (increases infection risk due to a weakened immune system).
- High-sodium or processed foods (may contribute to inflammation or bloating).
- Excess caffeine (can intensify restlessness or sleep disturbances).
Speak with your healthcare provider to create a diet plan that aligns with your treatment and overall health needs.
How successful is lenalidomide?
This medication has shown significant success in treating certain blood cancers, with studies highlighting its impact on survival rates and treatment outcomes. For multiple myeloma, clinical trials report response rates of 60-80%, and patients using Lenalidomide as maintenance therapy after stem cell transplants have seen a progression-free survival rate of over 50 months, compared to 22 months without it.
In myelodysplastic syndromes (MDS) with a deletion 5q chromosome abnormality, approximately 67% of patients achieved independence from blood transfusions, significantly improving their quality of life. These findings underscore the drug’s effectiveness in extending survival and managing complex conditions. Consult your healthcare provider to understand its role in your treatment plan.
How do I take lenalidomide for best results?
To take this medication for best results, follow these key points:
- Take it once daily, at the same time each day, with or without food.
- Swallow the capsule whole with water; do not open, break, or chew it.
- If you miss a dose, skip it if it’s close to the next one—do not double up.
- Attend regular check-ups and blood tests to monitor progress and side effects.
- Inform your doctor about any other medications or supplements you are taking.
Consistency and clear communication with your healthcare provider are essential for safe and effective treatment.
Why is this drug so expensive?
Lenalidomide is expensive due to factors such as its research and development costs, patent protection, and its critical role in treating serious conditions like multiple myeloma and myelodysplastic syndromes (MDS). The drug was developed through years of extensive research, costing billions of dollars, and its high price helps recoup these investments. As of recent years, the cost for a month’s supply of the brand-name medication ranges from $15,000 to $20,000, depending on the dosage.
Patent protection also keeps the price high by limiting competition. For example, Celgene, the original manufacturer, held exclusive rights for many years, allowing them to set the price without generic alternatives. Generic versions have started to enter the market, lowering costs significantly in some cases—by as much as 60-80%—but availability varies by region. The high price reflects its value as a life-extending treatment and the stringent regulatory processes required to ensure its safety and efficacy.
What is the recommended dose?
The recommended dose of Lenalidomide varies depending on the condition being treated, your health status, and other factors determined by your doctor. Always follow your healthcare provider’s instructions for the safest and most effective use.
Common recommended dosages:
- Multiple myeloma: 25 mg daily on days 1-21 of a 28-day cycle, combined with other therapies.
- Myelodysplastic syndromes (MDS): 10 mg daily, adjusted based on tolerance and blood counts.
- Mantle cell lymphoma: 25 mg daily on days 1-21 of a 28-day cycle.
- Kidney function adjustment: Reduced doses may be recommended for patients with impaired kidney function.
Your doctor will determine the best dosage for you based on your condition and response to treatment.
Does this tablet cause hair loss?
Lenalidomide does not typically cause hair loss, making it different from many traditional chemotherapy drugs. While hair loss is not a common side effect, it has been reported in less than 5% of patients during clinical trials. This low incidence means most people taking this drug for conditions like multiple myeloma or myelodysplastic syndromes (MDS) are unlikely to experience significant hair thinning or loss.
According to studies and patient reviews from recent years, side effects such as fatigue, nausea, or low blood counts are far more common than hair-related issues. If you do notice changes in your hair, it could be linked to other factors, such as additional medications or stress related to the condition itself. Consult your doctor if you have concerns about side effects to ensure proper management.
Are there any interactions?
Yes, Lenalidomide can interact with certain medications, supplements, and foods, which may affect its effectiveness or increase the risk of side effects. Always inform your healthcare provider about all the medications and supplements you are taking to avoid potential interactions.
| Type | Examples | Effect |
|---|---|---|
| Anticoagulants | Warfarin, Heparin | May increase the risk of bleeding; close monitoring is needed. |
| Immunosuppressants | Cyclosporine, Tacrolimus | Can heighten the risk of infection or suppress immune function further. |
| Other cancer drugs | Bortezomib, Dexamethasone | Can amplify side effects like low blood counts or fatigue. |
| Supplements | St. John’s Wort | May reduce Lenalidomide levels, making it less effective. |
| Foods | Grapefruit and grapefruit juice | Interferes with howthe drug is metabolized, increasing side effects. |
Monitoring medications, supplements, and dietary habits is essential to ensure the treatment remains effective and safe. Discussing potential interactions with your healthcare team helps avoid complications and supports optimal results.
What are the side effects?
Lenalidomide may cause side effects, which vary in severity depending on the individual. While some are common, others are less frequent but more serious. Understanding these effects can help you manage them effectively.
Common side effects:
- Fatigue: Experienced by up to 30-50% of patients.
- Low blood cell counts (anemia, neutropenia, or thrombocytopenia): Affecting around 20-40%, leading to fatigue, infections, or easy bruising.
- Nausea or diarrhea: Reported by 15-25% of patients.
- Skin rash: Occurs in approximately 10-20% of cases.
Serious side effects (less common):
- Blood clots: Seen in about 3-10% of patients; risk increases with other medications.
- Severe allergic reactions: Rare, but may require immediate medical attention.
- Secondary cancers: Very rare but possible with long-term use.
Managing these side effects often involves routine monitoring and adjustments to the treatment plan. Understanding the potential risks and symptoms allows for timely action to minimize discomfort and maintain the effectiveness of the therapy.
How long do you stay on lenalidomide?
The duration of treatment varies based on the condition and individual response. For multiple myeloma, it is commonly prescribed as maintenance therapy after a stem cell transplant and is typically continued indefinitely or until the disease progresses or side effects become unmanageable. Studies show many patients remain on Lenalidomide for 2-5 years or longer, depending on their response.
For myelodysplastic syndromes (MDS), the medication is often used for at least 16 weeks to assess its effectiveness, with many patients continuing treatment for several months to years as long as it stabilizes blood counts and is well-tolerated. The exact duration is tailored to the patient’s needs and monitored regularly by the healthcare team.
About the Author
Dr. Alice P. Chung, MD, is a renowned surgical oncologist in Beverly Hills, California, with over 20 years of experience. Affiliated with Cedars-Sinai Medical Center, she specializes in oncology and surgical oncology, with expertise in mastectomy and complex oncologic conditions. A 2000 graduate of Chicago Medical School, Dr. Chung completed her surgical residency at Cedars-Sinai, mastering advanced techniques. Board-certified in surgery and a Fellow of the American College of Surgeons (FACS), she is recognized for her compassionate care and clinical excellence. Licensed in California and New York, she is also certified in CMS Meaningful Use Stage 1 through EpicCare EMR. Known for her dedication to innovative surgical solutions and patient-centered care, Dr. Chung is highly regarded by patients and colleagues for her expertise and personalized approach. She remains committed to advancing the field of surgical oncology through both her clinical practice and advocacy for cutting-edge treatments.
Disclaimer: This page provides general information and is not intended to replace professional medical advice, diagnosis, or treatment. Consult a qualified healthcare professional for personalized medical guidance. Never disregard or delay seeking advice from a healthcare provider due to something you have read here.