Gupta et al Journal of Drug Delivery & Therapeutics; 2014, 4(3), 87-90 87 © 2011, JDDT. All Rights Reserved ISSN: 2250-1177 CODEN (USA): JDDTAO Available online at http://jddtonline.info Journal of Drug Delivery and Therapeutics Open access to Pharmaceutical and Medical research © 2014, publisher and licensee JDDT, This is an Open Access article which permits unrestricted noncommercial use, provided the original work is properly cited MINI REVIEW LENALIDOMIDE: RECENT ARMAMENTARIUM IN MANAGEMENT OF MULTIPLE MYELOMA *Dr Gupta Ajay K, Dr Sharma Ashok K, Dr Khadka Anjan, Dr Sharma Sushil, Dr Dahiya Navdeep, Dr Brashier DB Armed Forces Medical College (AFMC), Department of Pharmacology, Pune-40, India *Corresponding author: Dr AK Gupta, Associate Professor, Department of Pharmacology, AFMC, Wanworie, Pune- 40, Postal code- 411040 ajayneera2007@rediffmail.com +919765090428 INTRODUCTION Lenalidomide is a novel oral immunomodulatory derivative of thalidomide with potent activity and with a much improved toxicity profile to the parent compound. Thalidomide has a potential to treat inflammatory and neoplastic condition like multiple myeloma but was withdrawn from the market after its teratogenic effects were established. 1 Lenalidomide, a potent analogue of thalidomide was developed with improvement in safety and efficacy than the parent drug, thalidomide.It was created using thalidomide as a template by adding an amino group to the 4th carbon of the phthaloyl ring and removal of a carbonyl group. Lenalidomide possesses immunomodulatory, anti- angiogenic, antineoplastic and anti-inflammatory activities. Lenalidomide has been extensively studied and approved for refractory / relapsing multiple myeloma (MM), mantle cell lymphoma (MCL) and myelodysplastic syndromes (MDS). 2 Multiple myeloma is a B cell malignancy characterized by accumulation of plasma cell clone in the bone marrow, monoclonal protein in serum and/or urine, reduced immunoglobulin levels and lytic bone disease. 3 Alkylating agents, anthracyclines and corticosteroids were commonly used drugs in multiple myeloma which extended patient’s survival to median 3- 4 yearsas compared to median survival of 4-5 years with high dose of these drugs followed by autologous transplantation. 4 Due to the development of tumor cell resistance to all therapies, multiple myeloma still remains incurable, requiring further study on novel treatment strategies. 5 The survival in MM patients has improved significantly in the past decade due to the introduction of novel agents including immunomodulatory drugs (thalidomide, lenalidomide and pomalidomide), proteasome inhibitors (bortezomib, carfilzomib, marizomib and ixazomib citrate), monoclonal antibodies (elotuzumab, siltuximab, daratumumab and BT-062), and drugs affecting an interaction with the tumor microenvironment (anti-VLA4 monoclonal antibody, chemokine CXCR4 inhibitor AMD-3100 and selectin inhibitor GMI-1070). 6-8 Lenalidomide has been found to be more potent in the stimulation of T-cell proliferation and INF gamma and IL-2 production than thalidomide, whereas both thalidomide and pomalidomide, another thalidomide analogue, have been found to be more potent at inhibiting sprout formation than lenalidomide when antiangiogenic properties were assessed in a human umbilical explant model. Thalidomide was associated with dose-limiting toxicities including somnolence, constipation, neuropathy, and increased incidence of venothromboembolism (VTE), especially when combined with dexamethasone 9 .No clinical trials directly comparing these agents have been performed, lenalidomide appears to have a lower incidence of constipation, peripheral neuropathy, and somnolence than thalidomide. 2 Structure (RS)-3-(4-Amino-1-oxo 1,3-dihydro-2H-isoindol- 2- yl)piperidine-2,6-dione ABSTRACT Lenalidomide is an analogue of thalidomide. It is an oral immunomodulatory compound with potent activity and different toxicity profile than thalidomide. Lenalidomide is one of the novel drug agents used to treat multiple myeloma. Multiple myeloma (MM) is a B cell malignancy characterized by excess monotypic plasma cells in the bone marrow. Lenalidomide in combination with dexamethasone is one of the most promising MM novel treatment options. It induces at least additive direct cytotoxicity in multiple myeloma cells.The lenalidomide has possibility of being used as an adjuvant in support of more specific immunotherapeutic interventions including cancer chemotherapy, anticancer vaccines and adoptively transferred cells which warrants further investigation. Key words: Dexamethasone, Immunomodulation, Lenalidomide, Multiple myeloma