TY - JOUR T1 - Skin rash after immunomodulatory drugs for plasma cell neoplasms: effective practical corticosteroid desensitisation regimen JF - BMJ Supportive & Palliative Care JO - BMJ Support Palliat Care DO - 10.1136/spcare-2022-004030 SP - spcare-2022-004030 AU - Naveed Ali AU - Hannah Schmikla AU - Rishil Chopra AU - George Brown AU - Pingfu Fu AU - Shufen Cao AU - James Driscoll AU - Gayathri Ravi AU - Willem Van Heeckeren AU - Ehsan Malek Y1 - 2022/11/21 UR - http://spcare.bmj.com/content/early/2022/11/21/spcare-2022-004030.abstract N2 - 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 … ER -