Navigating the Nexus: Lenalidomide-Associated Thrombotic Thrombocytopenic Purpura

Thrombotic thrombocytopenic purpura (TTP) is a life-threatening thrombotic microangiopathy (TMA) marked by thrombocytopenia, microangiopathic hemolytic anemia, and microvascular thrombosis leading to end-organ damage. While TTP commonly results from hereditary or acquired ADAMTS13 deficiency, its as...

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Bibliographic Details
Published in:Curēus (Palo Alto, CA) CA), 2024-06, Vol.16 (6), p.e62975
Main Authors: Akhdar, Ghida, Akpan, Inemesit
Format: Article
Language:English
Subjects:
Anemia
Antibodies
Apheresis
Autoimmune diseases
Blood platelets
Chemotherapy
Clinical outcomes
Congenital diseases
Creatinine
Drug dosages
Enzymes
Hematology
Hemoglobin
Immunomodulators
Immunotherapy
Internal Medicine
Mortality
Multiple myeloma
Oncology
Plasma
Purpura
Remission (Medicine)
Stem cell transplantation
Targeted cancer therapy
Thrombocytopenia
Thrombosis
Tumor necrosis factor-TNF
Vascular endothelial growth factor
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Summary:Thrombotic thrombocytopenic purpura (TTP) is a life-threatening thrombotic microangiopathy (TMA) marked by thrombocytopenia, microangiopathic hemolytic anemia, and microvascular thrombosis leading to end-organ damage. While TTP commonly results from hereditary or acquired ADAMTS13 deficiency, its association with lenalidomide is notably rare. The link between lenalidomide and TMA is unclear and requires more studies, given the high mortality risk associated with TTP. The underlying mechanism may involve immunomodulatory effects leading to ADAMTS13 inhibitory antibody formation.Herein, we present a case of a 56-year-old male with a history of multiple myeloma status post autologous stem cell transplant, on lenalidomide maintenance therapy for over five years, who presented with progressive weakness, jaundice, palpitations, and paraesthesia in his extremities. On arrival, the patient was afebrile and was neurologically intact except for the subjective paraesthesia. He was found to have critically low ADAMTS13 activity at
ISSN:2168-8184
2168-8184
DOI:10.7759/cureus.62975