Chest
Selected ReportsAcute Lung Toxicity Related to Pomalidomide
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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Cited by (25)
Pembrolizumab, pomalidomide, and low-dose dexamethasone for relapsed/refractory multiple myeloma
2017, BloodCitation Excerpt :None of the cases resulted in infection, compromised lung function, or death. The incidence of pneumonitis in the current study is similar to what is reported for PD-1 antibody therapy, and surprisingly, not much higher despite the combination with pomalidomide, which has been associated with pneumonitis.33 Other autoimmune effects were grade 1 and 2 and were easily managed with hormone therapy and supportive care.
Pomalidomide-induced pulmonary toxicity in multiple myeloma
2015, American Journal of the Medical SciencesPulmonary toxicity associated with the use of lenalidomide: Case report of late-onset acute respiratory distress syndrome and literature review
2014, Heart and Lung: Journal of Acute and Critical CareCitation Excerpt :Some authors have suggested that frequent prescription of dexamethasone in combination with lenalidomide could reduce the occurrence of this toxicity.10 Pulmonary toxicity has also been described with other IMIDs, thalidomide and pomalidomide.20–23 One case of lenalidomide-induced pneumonitis occurred after previous pneumonitis during thalidomide treatment.14
Pomalidomide
2013, BloodCitation Excerpt :Infections were seen in 12% of patients,27 primarily pneumonia, which was seen in 10% of patients.27 Acute noninfectious pulmonary toxicity has been described in 2 patients.44 This injury seems to respond to corticosteroids, and reintroduction of pomalidomide has been successful.
Immunosuppressive Therapy for Autoimmune Lung Diseases
2012, Immunology and Allergy Clinics of North AmericaCitation Excerpt :Another trial reported superiority of minocycline over hydroxychloroquine for symptom control and prednisone-sparing over a 2-year study period.126 Macrolides (eg, erythromycin), neomacrolides (eg, clarithromycin), and azalides (eg, azithromycin) also have both antiinflammatory and antimicrobial properties,127 and they have been shown to have clinical benefit or promise in treating bronchiolitis (eg, diffuse pan-bronchiolitis, bronchiolitis obliterans syndrome [BOS]) cystic fibrosis (CF) bronchiectasis, non-CF bronchiectasis, COPD, and asthma.122–129 These agents can inhibit the respiratory burst of neutrophils, and they can also suppress cytokine production (eg, IL-8, IL-6, TNF-α).
Pomalidomide-induced lung injury: A case report
2023, Medicine (United States)
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