Lenalidomide-induced pure red cell aplasia is associated with elevated expression of MHC-I molecules on erythrocytes

Qi Hu, Yang Liu, Qiuyu Yue, Shuo Zhou, Xianghong Jin, Fan Lin, Xiao-Jun Huang, Junling Zhuang (), Jin Lu (), Xiaofei Gao () and Hsiang-Ying Lee ()
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Qi Hu: Peking University
Yang Liu: National Clinical Research Center for Hematologic Disease
Qiuyu Yue: Peking University
Shuo Zhou: Peking University
Xianghong Jin: Chinese Academy of Medical Sciences
Fan Lin: National Clinical Research Center for Hematologic Disease
Xiao-Jun Huang: Peking University
Junling Zhuang: Chinese Academy of Medical Sciences
Jin Lu: National Clinical Research Center for Hematologic Disease
Xiaofei Gao: Westlake University
Hsiang-Ying Lee: Peking University

Nature Communications, 2024, vol. 15, issue 1, 1-13

Abstract: Abstract The RVd therapy, combining lenalidomide, bortezomib, and dexamethasone, is a mainstay treatment for multiple myeloma. A multiple myeloma patient developed pure red cell aplasia (PRCA) following RVd treatment, despite the absence of common PRCA triggers. In vitro analyses reveal lenalidomide as a pivotal disruptor of erythropoiesis. Single-cell transcriptome analysis unveils hyperactive CD8+ T cells and impaired erythropoiesis in the patient’s bone marrow. Unexpectedly, the patient’s erythroid cells display abnormally high expression of genes in the antigen presentation pathway, particularly those for major histocompatibility class I (MHC-I) molecules. Functional assays demonstrate that lenalidomide treatment further augmented MHC-I expression in the patient’s erythroid cells. Blocking MHC-I or depleting T cells alleviates the defective erythropoiesis of PRCA, suggesting that the interaction between erythroid cells with elevated MHC-I and T cells in the bone marrow might contribute to PRCA. Taken together, our study implicates a mechanism underlying lenalidomide-induced PRCA in treating cancer patients.

Date: 2024
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DOI: 10.1038/s41467-024-54571-w

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