Lenalidomide-Associated ITP

Table 1

Key clinical time points and relevant studies.

	MM diagnosis; (14 months prior to ITP diagnosis)	Lenalidomide discontinuation; (17 days prior to ITP diagnosis)	ITP diagnosis
WBC/HGB/PLT	8.3/15.5/253	3.1/13.3/147	4.3/13.2/1
MM labs	Normal SPEP; IFE: detectable free kappa light chain; Serum FLC: elevated kappa light chain (91 mg/dL), elevated kappa: lambda ratio (120)	Normal SPEP; IFE: no monoclonal component; Serum FLC: normal
Other labs	Serum creatinine 1.2 mg/dL	Serum creatinine 0.9 mg/dL; Direct Coombs’ test negative	Serum chemistries normal; LDH normal; TSH normal; HIV negative; Hepatitis B and C negative; ANA 1 : 160; Anticardiolipin antibodies negative; Direct Coombs’ test negative; Lenalidomide drug-dependent antibodies negative
Peripheral blood film			Peripheral blood film with thrombocytopenia, no schistocytes or dysplasia
Bone marrow	Normocellular bone marrow with trilineage hematopoesis, 2% plasma cells		Normocellular bone marrow with trilineage hematopoesis, adequate megakaryocytes, 2% plasma cells, normal cytogenetics

FLC: free light chains; HGB: hemoglobin; IFE: immunofixation electrophoresis; ITP: immune thrombocytopenic purpura; MM: multiple myeloma; PLT: platelet count; SPEP: serum protein electrophoresis; WBC: white blood cell count.