Lenalidomide‑associated pure red cell aplasia during the treatment of POEMS syndrome: A case report and brief review of the literature

Lenalidomide is widely used in the treatment of hematological malignancies, with bone marrow suppression being one of the most common hematological adverse effects associated with its use. However, lenalidomide-associated pure red cell aplasia (PRCA) remains exceptionally rare. The present study describes a case of PRCA secondary to lenalidomide therapy in a patient with POEMS syndrome. A 61-year-old woman diagnosed with POEMS syndrome received lenalidomide (25 mg/day) in combination with dexamethasone. Following 3 months of treatment, she developed severe anemia accompanied by a markedly reduced absolute reticulocyte count. Bone marrow aspiration and biopsy demonstrated a complete absence of erythroid precursors, establishing the diagnosis of PRCA. After excluding other potential causes, including viral infections, malignancies and alternative drug-related toxicities, lenalidomide was considered the most likely etiology. Lenalidomide was discontinued, and the patient was subsequently treated with cyclosporine and corticosteroids. Her anemia markedly improved after 16 weeks of therapy, with the normalization of the reticulocyte count. No recurrence was observed during 6 months of follow-up. The present study also performed a brief review of the literature, discussing this rare phenomenon.