Lenalidomide treats multiple myeloma and myelodysplastic syndromes (MDS) by strengthening the immune system and boosting blood cell production.
Though it’s effective, lenalidomide can also lower hemoglobin levels, which leads to anemia.
Knowing how lenalidomide does this can help you manage this risk and stay on track with treatment.
Can Lenalidomide Lower Hemoglobin Levels: Short Answer
Yes, lenalidomide can lower hemoglobin levels and cause anemia.
The drug treats conditions like multiple myeloma and MDS effectively, but it also impacts the bone marrow, where red blood cells are produced.
By suppressing bone marrow activity, lenalidomide reduces red blood cell production, leading to lower hemoglobin.
The MDS-004 study showed that lenalidomide helped patients with MDS reduce their need for blood transfusions.
However, it also noted cases of anemia as a side effect, proving the potential for lenalidomide to lower hemoglobin even as it improves other symptoms.
How Lenalidomide Lowers Hemoglobin
Lenalidomide affects the immune system and stimulates blood cell growth, but it also reduces bone marrow activity.
Since the bone marrow produces red blood cells, this suppression can lead to fewer red blood cells.
In the MDS-001 study, some patients developed pancytopenia—a drop in all blood cell types, including red blood cells—shortly after starting lenalidomide. This decline often happens within the first few weeks of treatment.
With fewer red blood cells, hemoglobin levels decrease, reducing the body’s ability to transport oxygen.
This shortage of red blood cells also causes anemia symptoms, including fatigue, shortness of breath, and pale skin.
Signs Of Dropped Hemoglobin Levels
Low hemoglobin prevents the body from getting enough oxygen, leading to several symptoms. The most common signs include:
- Fatigue: Lower hemoglobin reduces the body’s oxygen levels, which can cause extreme tiredness, even with rest.
- Shortness of Breath: Basic activities may become challenging, as reduced oxygen causes shortness of breath.
- Dizziness: With less oxygen reaching the brain, dizziness or lightheadedness is common.
- Pale Skin: People with low hemoglobin may notice their skin, lips, and nail beds looking paler than usual.
- Cold Hands and Feet: Reduced oxygen in the blood can make extremities feel colder than normal.
- Fast Heart Rate: The heart works harder to circulate oxygen, which may increase the heart rate.
What to Do If You Notice These Symptoms
If you experience any of these symptoms, consult your doctor. Severe anemia can lead to serious complications, such as chest pain, fainting, or confusion, which need immediate medical attention.
Who Has a Higher Risk of Low Hemoglobin with Lenalidomide?
Certain patients are more likely to see a drop in hemoglobin while using lenalidomide. If you fall into one of these groups, your doctor may suggest extra monitoring during treatment.
Higher-Risk Groups
- Patients with Low Platelet Counts: The MDS-003 study found that people with low platelet counts before treatment are more likely to develop anemia. Lenalidomide affects bone marrow, which makes both platelets and red blood cells.
- Older Adults: Bone marrow makes fewer blood cells with age. This means older adults are at higher risk of anemia while taking lenalidomide because their bone marrow recovers more slowly.
- Patients with Kidney Problems: The kidneys make Erythropoietin, which helps produce red blood cells. When the kidneys don’t work well, it’s harder for the body to replace red blood cells lost due to lenalidomide.
- Patients Who Have Had Chemotherapy: Chemotherapy can damage bone marrow, making it harder to produce red blood cells. Lenalidomide can make this problem worse.
Tracking Hemoglobin Levels During Lenalidomide Use
Regular blood tests are the best way to catch anemia early. Your doctor will tell you how often you need to get tested, but here’s a general overview.
Recommended Testing Frequency
During the first eight weeks, Bristol-Myers Squibb recommends weekly tests to check hemoglobin levels.
According to the MDS-004 trial, weekly monitoring during this period helps catch anemia early. Anemia often develops soon after starting treatment, so frequent testing in the early stages is important.
At the same time, patients may want to consider Lenalidomide cost, as regular testing and treatment adjustments can add up.
Past the initial eight weeks, tests may be scheduled less frequently, though high-risk patients may need ongoing, regular testing to monitor for changes in hemoglobin levels.
How Low Hemoglobin Is Managed in Lenalidomide Patients
There’s more than one way to take care of this side effect. Here’s an overview of everything.
1. Dose Adjustments
Doctors may lower the dose or pause treatment to help hemoglobin levels recover. In the MDS-001 study, 58% of patients needed dose changes, but most still saw improvement. Since the lenalidomide dose goes down, the overall price of Lenalidomide in the treatment is also reduced.
2. Blood Transfusions
If hemoglobin falls too low, blood transfusions can quickly restore levels. Transfusions offer relief from symptoms like fatigue and shortness of breath and help manage severe anemia effectively.
3. Erythropoiesis-Stimulating Agents (ESAs)
ESAs such as epoetin alfa can stimulate red blood cell production. Doctors sometimes prescribe these to support red blood cell counts during lenalidomide treatment. However, ESAs carry a risk of blood clots, so they require careful management.
4. Iron and Vitamin Supplements
Low levels of iron, folate, or vitamin B12 can worsen anemia, so doctors may recommend supplements if blood tests show a deficiency. These supplements provide the nutrients needed for red blood cell production, reducing the severity of anemia.
5. Temporary Treatment Pauses
A short break from lenalidomide can give bone marrow time to recover and allow hemoglobin levels to rise. After this pause, doctors often resume treatment at a lower dose to minimize further risk of anemia.
FAQs
Does lenalidomide always lower hemoglobin levels?
No. Many patients maintain normal hemoglobin. However, because anemia is a common side effect, doctors monitor blood regularly.
Can doctors pause treatment if anemia is severe?
Yes. Doctors may stop lenalidomide temporarily to let hemoglobin levels recover, then restart it at a lower dose if needed.
Can anemia be managed without stopping lenalidomide?
Often, yes. Doctors can adjust the dose, provide medications to boost red blood cell production or recommend iron and vitamins. Blood transfusions are also used when necessary.
Conclusion
So yes, lenalidomide can make your blood count go down.
This might make you feel tired, but don’t worry – it’s a common issue that doctors know how to handle. Your doctor will check your blood often and can adjust your medicine or give you extra blood if needed.
