1例来那度胺相关药物性肝损伤病例报道和文献分析

Lenalidomide-induced liver injury: a case report and literature review

摘要:

目的 探讨来那度胺致肝损伤的临床特点。方法 报道某肿瘤医院收治的1例来那度胺致肝衰竭患者的诊治过程，并检索PubMed、Embase、中国知网及万方数据库（截至2024年4月1日），收集相似病例的主要临床资料（性别、年龄、疾病、用法用量、应用来那度胺至肝损伤发生的时间、临床处理、转归等），结合本病例资料进行汇总分析。结果 共纳入6例来那度胺致肝损伤患者，其中1例患者性别和年龄未报道，其余男性3例，女性2例；年龄50~93岁，中位年龄57岁；多发性骨髓瘤（MM）5例，骨髓增生异常综合征（MDS）1例。6例患者中，病例1表现为明显的胆汁淤积，病例2为伴轻度肝移植物抗宿主病的急性肝炎，病例3为急性乙型肝炎相关肝功能衰竭，病例4为无症状的转氨酶升高，病例5为急性肝损伤。病例6为本文报道病例。6例患者中有4例伴有肾功能不全，表明肾功能降低时更容易发生肝毒性。肝功能损伤可发生在来那度胺用药后的第1或第2个疗程。肝功能恢复正常的中位时间为28（8~54）d。停用来那度胺、对症支持治疗后，肝功能标志物水平逐渐降低，肝损伤症状得到缓解。结论 不同性别、不同年龄的MM或MDS患者使用来那度胺化疗后均有发生肝损伤的可能，尤其是伴肾功能不全的患者，停药后对症治疗，临床症状均可缓解。

Abstract:

Objective To explore the clinical characteristics of lenalidomide-induced liver injury.Methods The diagnosis and treatment of a patient with hepatic failure caused by lenalidomide in a cancer hospital was reported. The main clinical data (gender, age, disease, usage and dosage of lenalidomide, combined medication, time from medication to hepatic failure onset, the treatment and outcome, etc.) of this case and relevant cases which were searched from PubMed, Embase, CNKI, and Wanfang database (as of April 1, 2024) were summarized and analyzed.Results A total of 6 cases of lenalidomide-induced liver injury were enrolled in the study, including 3 males and 2 females with 1 unknown gender, aged from 50 to 93 years, with a median age of 57 years. The primary diseases included multiple myeloma (MM) in 5 cases, and myelodysplastic syndrome (MDS)in 1 case. Of the 6 cases, case 1 presented with predominated cholestasis. Case 2 had acute hepatitis with mild liver graft-versus-host action. Case 3 had acute hepatitis B-associated liver failure. Case 4 had asymptomatic elevated aminotransferase, and case 5 had acute liver injury. Case 6 was the case reported in this paper. Four of the six patients were accompanied by renal insufficiency, indicating that hepatotoxicity is more likely to occur when renal function is reduced.Liver dysfunction may occur in the first or second course of lenalidomide. The median time of liver function recovery was 28 (8~54) days. After withdrawal of lenalidomide and symptomatic and supportive treatment, the levels of liver function markers gradually decreased, and the symptoms of liver injury were relieved.Conclusion Liver injury may occur in MM or MDS patients of different genders and ages after lenalidomide chemotherapy, especially in patients with renal insufficiency. The clinical symptoms can be relieved after drug withdrawal and symptomatic treatment.