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

  • Authors:
    • Minghui Dai
    • Qiuling Li
    • Xiaohong Kuang
    • Jiaxun Wei
    • Wei Jiang
    • Lin Zhang
    • Ling Li
    • Yan Zou
  • View Affiliations / Copyright

    Affiliations: Department of Hematology, The Third Hospital of Mianyang, Sichuan Mental Health Center, Mianyang, Sichuan 621000, P.R. China, Department of Hematology, The Third Hospital of Mianyang, Sichuan Mental Health Center, Mianyang, Sichuan 621000, P.R. China, Hongyuan County People's Hospital of Sichuan Province, Hongyuan, Sichuan 624400, P.R. China, Hongyuan County People's Hospital of Sichuan Province, Hongyuan, Sichuan 624400, P.R. China
    Copyright: © Dai et al. This is an open access article distributed under the terms of Creative Commons Attribution License [CC BY 4.0].
  • Article Number: 84
    |
    Published online on: October 29, 2025
       https://doi.org/10.3892/mi.2025.283
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Abstract

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.
View Figures

Figure 1

Flow cytometric analysis for
paroxysmal nocturnal hemoglobinuria. Representative histograms
illustrating the normal expression of CD55 and CD59 in red blood
cells. No paroxysmal nocturnal hemoglobinuria clone was
detected.

Figure 2

(A) Bone marrow smear findings.
Hypercellular marrow illustrating 64.5% granulocytic and ~1%
erythroid cells, with no evidence of blasts or dysplasia
(Wright-Giemsa staining; magnification, x100; scale bar, 20 µm).
(B) Bone marrow biopsy findings. Hypercellular marrow (~50%) with
granulocytic predominance and markedly reduced erythropoiesis
(hematoxylin and eosin staining; magnification, x40; scale bar, 100
µm).
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Copy and paste a formatted citation
Spandidos Publications style
Dai M, Li Q, Kuang X, Wei J, Jiang W, Zhang L, Li L and Zou Y: Lenalidomide‑associated pure red cell aplasia during the treatment of POEMS syndrome: A case report and brief review of the literature. Med Int 5: 84, 2025.
APA
Dai, M., Li, Q., Kuang, X., Wei, J., Jiang, W., Zhang, L. ... Zou, Y. (2025). Lenalidomide‑associated pure red cell aplasia during the treatment of POEMS syndrome: A case report and brief review of the literature. Medicine International, 5, 84. https://doi.org/10.3892/mi.2025.283
MLA
Dai, M., Li, Q., Kuang, X., Wei, J., Jiang, W., Zhang, L., Li, L., Zou, Y."Lenalidomide‑associated pure red cell aplasia during the treatment of POEMS syndrome: A case report and brief review of the literature". Medicine International 5.6 (2025): 84.
Chicago
Dai, M., Li, Q., Kuang, X., Wei, J., Jiang, W., Zhang, L., Li, L., Zou, Y."Lenalidomide‑associated pure red cell aplasia during the treatment of POEMS syndrome: A case report and brief review of the literature". Medicine International 5, no. 6 (2025): 84. https://doi.org/10.3892/mi.2025.283
Copy and paste a formatted citation
x
Spandidos Publications style
Dai M, Li Q, Kuang X, Wei J, Jiang W, Zhang L, Li L and Zou Y: Lenalidomide‑associated pure red cell aplasia during the treatment of POEMS syndrome: A case report and brief review of the literature. Med Int 5: 84, 2025.
APA
Dai, M., Li, Q., Kuang, X., Wei, J., Jiang, W., Zhang, L. ... Zou, Y. (2025). Lenalidomide‑associated pure red cell aplasia during the treatment of POEMS syndrome: A case report and brief review of the literature. Medicine International, 5, 84. https://doi.org/10.3892/mi.2025.283
MLA
Dai, M., Li, Q., Kuang, X., Wei, J., Jiang, W., Zhang, L., Li, L., Zou, Y."Lenalidomide‑associated pure red cell aplasia during the treatment of POEMS syndrome: A case report and brief review of the literature". Medicine International 5.6 (2025): 84.
Chicago
Dai, M., Li, Q., Kuang, X., Wei, J., Jiang, W., Zhang, L., Li, L., Zou, Y."Lenalidomide‑associated pure red cell aplasia during the treatment of POEMS syndrome: A case report and brief review of the literature". Medicine International 5, no. 6 (2025): 84. https://doi.org/10.3892/mi.2025.283
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