Development of thrombotic thrombocytopenic purpura during lenalidomide therapy: three new cases and review of literature.

Thrombotic thrombocytopenic purpura (TTP) is a rare and life-threatening thrombotic microangiopathy (TMA) syndrome (Kremer et al. [8]). These three cases of TTP occurred during lenalidomide therapy (Table)- there was nothing that can usually be associated with thrombotic microangiopathy - no infectious trigger, no association with other autoimmune disorders, and no drugs intake. For our patients, the presence of anti-ADAMTS13 antibodies in each case and the efficacy of TPE and/or rituximab therapies imply an immune-mediated reaction. Montefusco et al. ([10]) described six autoimmune diseases after lenalidomide administration to 140 patients (4-3%): three autoimmune cytopenias and three organ-specific autoimmune disorders, occurring mostly in the first months of treatment. [Extracted from the article]