Lenalidomide a phthalimide derivative, binds the E3 ligase cereblon to promote degradation of transcription factors like IKZF1 and IKZF3, leading to anti-proliferative and immunomodulatory effects which are critical for tumor survival and immune evasion in multiple myeloma. This promotes tumor cell death and enhances immune responses by stimulating NK cell cytotoxicity and modulating the tumor microenvironment. These immunomodulatory effects support antiviral responses and have potential to synergize with OVT. This evidence concerns the gene IKZF3 and AL amyloidosis.