Autoimmune diseases during treatment with immunomodulatory drugs in multiple myeloma: selective occurrence after lenalidomide

Abstract Immunomodulatory drugs (IMiDs) may favour autoimmune diseases (ADs) occurrence. We conducted a retrospective study to evaluate ADs occurrence among IMIDs-treated myeloma patients. Patients were grouped into three classes depending on the type of IMID used. The first group included patients treated with thalidomide (Thal) (n=474), the second group with lenalidomide (Len) (n=140), while patients in the third group were first treated with Thal followed by Len (Thal-Len) (n= 94). Absolute risk of AD was 0.4% for patients treated with Thal, 4.3% for Len, and 1.1% for Thal-Len group. ADs manifested prevalently as autoimmune cytopenias (55%), although we observed one vasculitis, one optic neuritis, one Grave's disease, and one polymiositis. ADs occurred preferentially in the first months of IMiD treatment. A previous autologous transplant was shown to be a significant risk factor. All ADs were managed with IMiD discontinuation and steroids, resolving in few weeks, except for Grave's disease and polymiositis