Lenalidomide

INTRODUCTION

Indications

Transfusion-dependent anemia due to specific myelodysplastic syndromes associated with deletion 5q cytogenetic abnormality.

Action

Lenalidomide is a structural analogue of thalidomide. Inhibits secretion of proinflammatory cytokines and increases secretion of anti-inflammatory cytokines. Therapeutic Effects: Decreased anemia in certain myelodysplastic syndromes with a decreased requirement for transfusions.

Adverse Reactions/Side Effects

CNS: dizziness, fatigue, headache, insomnia, depression. Resp: cough, pharyngitis. CV: PULMONARY EMBOLISM, edema, chest pain, deep vein thrombosis, palpitations. GI: abdominal pain, constipation, diarrhea, nausea, vomiting, abnormal taste, anorexia, dry mouth. Derm: STEVENS-JOHNSON SYNDROME, pruritus, rash, dry skin, sweating. Endo: hypothyroidism. F and E hypokalemia, hypomagnesemia. Hemat: NEUTROPENIA, THROMBOCYTOPENIA. MS: arthralgia, myalgia. Misc: fever, chills.

PHYSICAL THERAPY IMPLICATIONS

Examination and Evaluation

• Monitor signs of deep vein thrombosis (lower extremity swelling, warmth, erythema, tenderness) and pulmonary embolism (shortness of breath, chest pain, cough, bloody sputum). Notify physician or nursing staff immediately, and request objective tests (Doppler ultrasound, lung scan, others) if thrombosis is suspected.

• Monitor rashes or other skin reactions (hives, acne, abnormal sweating, exfoliation). Notify physician immediately because certain skin reactions may indicate serious hypersensitivity reactions (Stevens-Johnson syndrome).

• Be alert for signs of neutropenia (fever, sore throat, signs of infection) or thrombocytopenia (bruising, nose bleeds, bleeding gums). Report these signs to the physician or nursing staff immediately.

• Assess peripheral edema using girth measurements, volume displacement, and measurement of pitting edema (See Appendix N). Report increased swelling in feet and ankles or a sudden increase in body weight due to fluid retention.

• Monitor and report signs of decreased metabolism that might indicate hypothyroidism. Signs include bradycardia, lethargy, cold intolerance, weight gain, and muscle weakness.

• Report signs of electrolyte imbalances, including low potassium levels (headache, lethargy, weakness, cramping, muscle hyperexcitability, tetany) or low magnesium levels (irritability, insomnia, muscle tremors, confusion).

• Assess any joint or muscle pain to rule out musculoskeletal pathology; that is, try to determine if pain is drug induced rather than caused by anatomic or biomechanical problems.

• Assess dizziness that might affect gait, balance, and other functional activities (See Appendix C). Report balance problems and functional limitations to the physician and nursing staff, and caution the patient and family/caregivers to guard against falls and trauma.

Interventions

• For patients who are medically able to begin exercise, implement appropriate resistive exercises and aerobic training to maintain or restore muscle strength and aerobic capacity.

• Because of the risk of pulmonary thrombosis, use caution during aerobic exercise and other forms of therapeutic exercise. Assess exercise tolerance frequently (blood pressure, heart rate, fatigue levels), and terminate exercise immediately ...