Severe Renal Allograft Rejection Resulting from Lenalidomide Therapy for Multiple Myeloma: Case Report

Lenalidomide, a thalidomide analogue, is an immunomodulatory drug currently used as a chemotherapeutic agent in treating certain hematologic malignancies, including multiple myeloma. The antineoplastic effect of lenalidomide may be due to its ability to modulate different components of the immune system as well as its antiangiogenic, antiproliferative, and direct cytotoxic activity. Given its immunomodulatory effects, lenalidomide may potentially elicit unintended immune activity against allografts in solid organ transplant recipients. Here, we present a case of a renal transplant recipient who developed multiple myeloma after transplantation and was treated with the use of lenalidomide, which precipitated severe acute T-cell–mediated rejection. Lenalidomide was thought to be causative, and after cessation of the drug her renal function stabilized.