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Skin rash after immunomodulatory drugs for plasma cell neoplasms: effective practical corticosteroid desensitisation regimen
  1. Naveed Ali1,
  2. Hannah Schmikla1,
  3. Rishil Chopra1,
  4. George Brown1,
  5. Pingfu Fu2,
  6. Shufen Cao2,
  7. James Driscoll3,
  8. Gayathri Ravi4,
  9. Willem Van Heeckeren1 and
  10. Ehsan Malek5
  1. 1Department of Hematology and Oncology, UH Seidman Cancer Center, Cleveland, Ohio, USA
  2. 2Department of Population and Quantitative Health Sciences, Case Western Reserve University, Cleveland, Ohio, USA
  3. 3Case Western Reserve University, Cleveland, Ohio, USA
  4. 4Department of Hematology and Oncology, Mayo Clinic Rochester, Rochester, Minnesota, USA
  5. 5Department of Hematology and Oncology, Case Western Reserve University, Cleveland, Ohio, USA
  1. Correspondence to Dr Ehsan Malek, Department of Hematology and Oncology, Case Western Reserve University, Cleveland, OH 44106, USA; Ehsan.Malek{at}uhhospitals.org

https://doi.org/10.1136/spcare-2022-004030

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    Immunomodulatory drugs (IMiDs) are the backbone of myeloma therapy for patients with plasma cell neoplasm (PCN).1 Therapy is often complicated by development of dermatologic adverse effects associated with IMiDs and may herald a favourable prognosis suggesting a more robust immune stimulation by this class of drugs.2 The incidence of IMiD-associated rash is up to 27% in some reports impeding maximal benefit. Rash is usually mild to moderate, however, severe and life-threatening skin toxicity including Stevens-Johnson syndrome and toxic epidermal necrolysis have been reported.3 Lack of optimal management strategy of this toxicity can deprive a large subset of patients from maintenance therapy after transplant and lead to potentially detrimental impact on survivals. The concurrent weekly dexamethasone does not diminish the incidence of skin eruptions with IMiDs.4 Therefore, we designed a low dose daily and tapering corticosteroid regimen to tame this immune response on restarting IMiDs allowing desensitisation and reinstitution of the same IMiD. Herein, we describe the clinical course of patients with PCN who developed IMiD-associated skin eruptions. Furthermore, we assessed the impact of this desensitisation regimen on clinical outcomes.

    We reviewed all consecutive patients with PCN treated with IMiD (lenlaidomide and pomalidomide) between 2013 and 2019 for any dermatologic toxicity. Dermatologic toxicity was defined as morbilliform rash, urticarial and blisters that occurred after the initiation of …

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    Footnotes

    • Twitter @DrEhsanMalek

    • Presented at ASCO Meeting - This manuscript was previously published in abstract form or presented (oral or poster) at an ASCO meeting (including the Annual Meeting and thematic meetings).

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; internally peer reviewed.