Objective To explore the clinical characteristics of lenalidomide-induced liver injury.Methods The diagnosis and treatment of a patient with hepatic failure caused by lenalidomide in a cancer hospital was reported. The main clinical data (gender, age, disease, usage and dosage of lenalidomide, combined medication, time from medication to hepatic failure onset, the treatment and outcome, etc.) of this case and relevant cases which were searched from PubMed, Embase, CNKI, and Wanfang database (as of April 1, 2024) were summarized and analyzed.Results A total of 6 cases of lenalidomide-induced liver injury were enrolled in the study, including 3 males and 2 females with 1 unknown gender, aged from 50 to 93 years, with a median age of 57 years. The primary diseases included multiple myeloma (MM) in 5 cases, and myelodysplastic syndrome (MDS)in 1 case. Of the 6 cases, case 1 presented with predominated cholestasis. Case 2 had acute hepatitis with mild liver graft-versus-host action. Case 3 had acute hepatitis B-associated liver failure. Case 4 had asymptomatic elevated aminotransferase, and case 5 had acute liver injury. Case 6 was the case reported in this paper. Four of the six patients were accompanied by renal insufficiency, indicating that hepatotoxicity is more likely to occur when renal function is reduced.Liver dysfunction may occur in the first or second course of lenalidomide. The median time of liver function recovery was 28 (8~54) days. After withdrawal of lenalidomide and symptomatic and supportive treatment, the levels of liver function markers gradually decreased, and the symptoms of liver injury were relieved.Conclusion Liver injury may occur in MM or MDS patients of different genders and ages after lenalidomide chemotherapy, especially in patients with renal insufficiency. The clinical symptoms can be relieved after drug withdrawal and symptomatic treatment.