Chest
Volume 140, Issue 2, August 2011, Pages 529-533
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Selected Reports
Acute Lung Toxicity Related to Pomalidomide

https://doi.org/10.1378/chest.10-2082Get rights and content

Pomalidomide is an immunomodulatory derivative (IMiD) active in multiple myeloma. In this report, we review the course of two patients receiving pomalidomide therapy who subsequently developed dyspnea, fever, hypoxia, and ground-glass opacities on CT scan. An extensive workup for infectious causes was negative. Both patients improved with discontinuation of the medication and/or treatment with corticosteroids. Both patients were restarted on pomalidomide therapy at a lower dose, with one patient experiencing an immediate recurrence of pulmonary symptoms. The combination of symptoms, radiographic findings, clinical course, and response to treatment strongly supports the diagnosis of acute pulmonary toxicity secondary to pomalidomide. We then review previously published pulmonary toxicity data on thalidomide and lenalidomide and compare the described clinical courses, radiographic findings, and responses to treatment with those observed in our patients. We conclude that pulmonary toxicity is a potential adverse effect of pomalidomide therapy and encourage physicians to remain cognizant of its clinical presentation.

Section snippets

Case 1

A 70-year-old female patient with a 14-year history of multiple myeloma initiated treatment with pomalidomide 2 mg daily plus dexamethasone 40 mg weekly. She had no known history of cardiopulmonary disease but did have a history of tobacco use. Previous chemotherapy regimens had included thalidomide, melphalan, and a bone marrow transplant. She started pomalidomide treatment in August 2008 and remained under close surveillance. Approximately 480 days into treatment, she developed the abrupt

Discussion

Antineoplastic-associated pulmonary toxicity remains a well-documented complication of both hematologic and solid tumor malignancies. To date, 15 different antineoplastic medications have been implicated in causing pneumonitis, with an incidence ranging from 0.1% to 15%.14 Immunomodulatory agents, thalidomide and lenalidomide, have been cited in a growing body of evidence linking their administration to potential pulmonary toxicity. An analog of thalidomide, pomalidomide has shown efficacy in

Conclusion

In summary, we provide a brief review of two patients who developed pulmonary toxicity related to pomalidomide. The patients' clinical course, radiographic, and bronchoscopic findings are consistent with previously published reports of pulmonary toxicity related to pomalidomide analogs, thalidomide and lenalidomide. It remains imperative that clinicians be cognizant of this potential toxicity in patients presenting with pulmonary complaints and no identifiable infectious source, as timely

Acknowledgments

Financial/nonfinancial disclosures: The authors have reported to CHEST the following conflicts of interest: Dr Lacy receives research funding for clinical trials from Celgene. Dr Witzig served on a Celgene Advisory Board in 2009 without personal compensation. Drs Geyer, Viggiano, Leslie, Mikhael, and Stewart have reported that no potential conflicts of interest exist with any companies/organizations whose products or services may be discussed in this article.

Other contributions: The

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