Practical Approaches to the Use of Lenalidomide in Multiple Myeloma: A Canadian Consensus

Table 3

Lenalidomide dose adjustment for neutropenia.

Neutrophil count	Recommendations
<1 × 10^9/L on day 1 of a cycle	Delay start of the cycle for a week, until neutrophil count ≥1 × 10^9/L
<1 × 10^9/L during a cycle	Interruption of lenalidomide until next cycle (dexamethasone should be continued)
Returning to ≥1 × 10^9/L on next cycle	Continue lenalidomide at same dose ± addition of G-CSF, if no other significant toxicities needing dose reduction; Reduce lenalidomide to the first reduction level if other significant toxicities observed
For each subsequent drop <1 × 10^9/L	Interrupt lenalidomide treatment
Returning to ≥1 × 10^9/L on next cycle	Resume lenalidomide at next dose reduction level

G-CSF: granulocyte-colony stimulating factor.