ScholarlyCommons

Title

Lenalidomide Therapy in Treatment Refractory Cutaneous Lupus Erythematosus: Histologic and Circulating Leukocyte Profile and Potential Risk of a Systemic Lupus Flare

Author(s)

Inbal Braunstein
Noah G. Goodman, University of Pennsylvania
Misha Rosenbach, University of PennsylvaniaFollow
Joyce Okawa, University of PennsylvaniaFollow
Asha Shah, University of Pennsylvania
Michael Krathen, University of Pennsylvania
Carrie Kovarik, University of PennsylvaniaFollow
Eline Luning PrakFollow
Victoria P. Werth, University of PennsylvaniaFollow

Document Type

Journal Article

Date of this Version

4-2012

Publication Source

Journal of the American Academy of Dermatology

Volume

66

Issue

4

Start Page

571

Last Page

582

DOI

10.1016/j.jaad.2011.01.015

Abstract

Background

Lenalidomide is a thalidomide analogue that may serve as an adjunctive therapy for treatment refractory cutaneous lupus erythematosus (CLE).

Objectives

We evaluate the use of lenalidomide in CLE and describe the skin and circulating leukocyte profile of treatment refractory patients before and after treatment.

Patients/Methods

Five subjects were treated with lenalidomide in an unblinded open-label study. Immunohistochemistry of skin was performed for T-cell markers, glycosaminoglycans and CXCL10, an interferon (IFN)-inducible chemokine, before and after treatment. Immunophenotyping and measurement of IFN-inducible genes from peripheral blood mononuclear cells was also performed before and after treatment.

Results

Four subjects demonstrated clinical improvement of their skin, however one of these responders subsequently developed symptoms of systemic lupus erythematosus. Small changes in rare circulating leukocyte subsets, plasmacytoid dendritic cells and regulatory T-cells, were observed with treatment and may correlate with clinical response. Treatment was associated with increased circulating HLA-DR expression and decreased markers of IFN-mediated pathways, regardless of clinical response.

Limitations

Our results are limited by small sample size and the measurement of rare populations of circulating cell subsets.

Conclusions

Lenalidomide may have utility as therapy for severe, treatment refractory CLE. However, our preliminary data suggest that lenalidomide may activate T-cells and trigger systemic disease in some CLE patients. We also saw a unique histologic and circulating leukocyte phenotype in the nonresponding subject. Further characterization of the skin and circulating leukocyte profile of treatment refractory patients will improve our understanding of CLE.

Copyright/Permission Statement

NOTICE: This is the author’s version of a work that was accepted for publication in the Journal of the American Academy of Dermatology. Changes resulting from the publishing process, such as peer review, editing, corrections, structural formatting, and other quality control mechanisms, may not be reflected in this document. Changes may have been made to this work since it was submitted for publication. A definitive version was subsequently published in J Am Acad Dermatol. Apr 2012; 66(4): 571–582. doi: 10.1016/j.jaad.2011.01.015

Keywords

Lenalidomide, cutaneous lupus erythematosus, CLE

Recommended Citation

Braunstein, Inbal; Goodman, Noah G.; Rosenbach, Misha; Okawa, Joyce; Shah, Asha; Krathen, Michael; Kovarik, Carrie; Prak, Eline Luning; and Werth, Victoria P., "Lenalidomide Therapy in Treatment Refractory Cutaneous Lupus Erythematosus: Histologic and Circulating Leukocyte Profile and Potential Risk of a Systemic Lupus Flare" (2012). Botswana-UPenn Scholarly Publications. 17.
https://repository.upenn.edu/botswana_schol/17