DIARRHEA INCIDENCE IN MULTIPLE MYELOMA PATIENTS TREATED WITH LENALIDOMIDE AND POMALIDOMIDE
(Abstract release date: 05/19/16)
EHA Library. Capecchi M. 06/09/16; 134883; PB1983
Dr. Marco Capecchi
Contributions
Contributions
Abstract
Abstract: PB1983
Type: Publication Only
Background
Daily clinical practice in hematology is increasingly relying on novel biological drugs, with new toxicity profiles that hematologists should learn to manage. Immunomodulatory drugs (IMiDs) have a pivotal role in the treatment of multiple myeloma (MM), and are typically administered as a continuous treatment. Thalidomide is a well know constipation-inducing agent. On the contrary, physicians are aware that lenalidomide (Len) may induce gastrointestinal (GI) disorders, in particular diarrhea, but little is known of this side effect. Moreover, no specific data on GI side effects are reported on the third-generation IMiD Pomalidomide (Poma).
Aims
Description of incidence and management of diarrhea in a retrospective cohort of Len- or Poma-treated MM patients.
Methods
One hundred and twenty-six consecutive Len-treated, and 59 Poma-treated MM patients were retrospectively analyzed in terms of diarrhea occurrence. In this analysis we included Len patients consecutively treated from June 2005 to December 2015, and Poma patients consecutively treated from August 2010 to September 2015. A descriptive analysis of diarrhea incidence, onset time, and response to treatments was performed.
Results
The median age of the 126 Len-treated patients was 65 years (range 35-87); 57 (45%) received one or two autologous stem cell transplants, and 12 (10%) patients received an allogeneic stem cell transplant before Len start; 55 (44%) patients received Len as a first line therapy, 32 (25%) patients as a second line therapy, and 39 (31%) as third or subsequent line of therapy. Thirty (24%) patients had diarrhea during Len treatment. Among these patients, 27 (90%) had grade 1 diarrhea, 3 (10%) patients had grade 2 diarrhea, and no patients had grade 3 or more diarrhea. Seventeen (53%) patients had abdominal cramps and 2 (6%) patients had rectal tenesmus. Diarrhea occurred at a median of 10 cycles. Almost all patients (29, 97%) had a correlation of diarrhoeic episodes with assumption of food, and most patients (24, 80%) reported persistent diarrhea during the rest period. Since some patients reported a worsening of diarrhea associated to fat consumption, 14 patients were advised to avoid diary products, and in 9 of them (64%) a benefit was observed. Loperamide was used in all cases, and 19 (63%) patients had a reduction of symptoms. Eleven (37%) patients had a poor control with loperamide and were treated with cholestyramine, which was effective in all cases. Nine (30%) patients had Len dose reduction, and 5 had a reduction of the diarrhea. In 19 cases Len was stopped, resulting in the rapid resolution of diarrhea in all cases. The same analysis conducted in 57 Poma-treated patients did not show any GI symptoms.
Conclusion
Adverse GI events are common in new targeted drugs, and a better understanding of the underlying physiopathological mechanism is the basis for a correct management. In particular, IMiDs have a gastrointestinal toxicity profile with peculiar characteristics for the different generations. The first-generation IMiD Thalidomide is well known to be associated with constipation, sometimes very severe. The second-generation IMiD Len has an opposed GI toxicity profile, characterized by diarrhea. In our study diarrhea is mainly mild, but still quite disturbing. However, it seems that a combination of dietary counselling, along with loperamide and cholestyramine treatment may control this symptom. On the other side, we confirm that Poma doesn't have relevant GI side effects.
Session topic: E-poster
Keyword(s): Imids, Multiple myeloma, Toxicity
Type: Publication Only
Background
Daily clinical practice in hematology is increasingly relying on novel biological drugs, with new toxicity profiles that hematologists should learn to manage. Immunomodulatory drugs (IMiDs) have a pivotal role in the treatment of multiple myeloma (MM), and are typically administered as a continuous treatment. Thalidomide is a well know constipation-inducing agent. On the contrary, physicians are aware that lenalidomide (Len) may induce gastrointestinal (GI) disorders, in particular diarrhea, but little is known of this side effect. Moreover, no specific data on GI side effects are reported on the third-generation IMiD Pomalidomide (Poma).
Aims
Description of incidence and management of diarrhea in a retrospective cohort of Len- or Poma-treated MM patients.
Methods
One hundred and twenty-six consecutive Len-treated, and 59 Poma-treated MM patients were retrospectively analyzed in terms of diarrhea occurrence. In this analysis we included Len patients consecutively treated from June 2005 to December 2015, and Poma patients consecutively treated from August 2010 to September 2015. A descriptive analysis of diarrhea incidence, onset time, and response to treatments was performed.
Results
The median age of the 126 Len-treated patients was 65 years (range 35-87); 57 (45%) received one or two autologous stem cell transplants, and 12 (10%) patients received an allogeneic stem cell transplant before Len start; 55 (44%) patients received Len as a first line therapy, 32 (25%) patients as a second line therapy, and 39 (31%) as third or subsequent line of therapy. Thirty (24%) patients had diarrhea during Len treatment. Among these patients, 27 (90%) had grade 1 diarrhea, 3 (10%) patients had grade 2 diarrhea, and no patients had grade 3 or more diarrhea. Seventeen (53%) patients had abdominal cramps and 2 (6%) patients had rectal tenesmus. Diarrhea occurred at a median of 10 cycles. Almost all patients (29, 97%) had a correlation of diarrhoeic episodes with assumption of food, and most patients (24, 80%) reported persistent diarrhea during the rest period. Since some patients reported a worsening of diarrhea associated to fat consumption, 14 patients were advised to avoid diary products, and in 9 of them (64%) a benefit was observed. Loperamide was used in all cases, and 19 (63%) patients had a reduction of symptoms. Eleven (37%) patients had a poor control with loperamide and were treated with cholestyramine, which was effective in all cases. Nine (30%) patients had Len dose reduction, and 5 had a reduction of the diarrhea. In 19 cases Len was stopped, resulting in the rapid resolution of diarrhea in all cases. The same analysis conducted in 57 Poma-treated patients did not show any GI symptoms.
Conclusion
Adverse GI events are common in new targeted drugs, and a better understanding of the underlying physiopathological mechanism is the basis for a correct management. In particular, IMiDs have a gastrointestinal toxicity profile with peculiar characteristics for the different generations. The first-generation IMiD Thalidomide is well known to be associated with constipation, sometimes very severe. The second-generation IMiD Len has an opposed GI toxicity profile, characterized by diarrhea. In our study diarrhea is mainly mild, but still quite disturbing. However, it seems that a combination of dietary counselling, along with loperamide and cholestyramine treatment may control this symptom. On the other side, we confirm that Poma doesn't have relevant GI side effects.
Session topic: E-poster
Keyword(s): Imids, Multiple myeloma, Toxicity
Abstract: PB1983
Type: Publication Only
Background
Daily clinical practice in hematology is increasingly relying on novel biological drugs, with new toxicity profiles that hematologists should learn to manage. Immunomodulatory drugs (IMiDs) have a pivotal role in the treatment of multiple myeloma (MM), and are typically administered as a continuous treatment. Thalidomide is a well know constipation-inducing agent. On the contrary, physicians are aware that lenalidomide (Len) may induce gastrointestinal (GI) disorders, in particular diarrhea, but little is known of this side effect. Moreover, no specific data on GI side effects are reported on the third-generation IMiD Pomalidomide (Poma).
Aims
Description of incidence and management of diarrhea in a retrospective cohort of Len- or Poma-treated MM patients.
Methods
One hundred and twenty-six consecutive Len-treated, and 59 Poma-treated MM patients were retrospectively analyzed in terms of diarrhea occurrence. In this analysis we included Len patients consecutively treated from June 2005 to December 2015, and Poma patients consecutively treated from August 2010 to September 2015. A descriptive analysis of diarrhea incidence, onset time, and response to treatments was performed.
Results
The median age of the 126 Len-treated patients was 65 years (range 35-87); 57 (45%) received one or two autologous stem cell transplants, and 12 (10%) patients received an allogeneic stem cell transplant before Len start; 55 (44%) patients received Len as a first line therapy, 32 (25%) patients as a second line therapy, and 39 (31%) as third or subsequent line of therapy. Thirty (24%) patients had diarrhea during Len treatment. Among these patients, 27 (90%) had grade 1 diarrhea, 3 (10%) patients had grade 2 diarrhea, and no patients had grade 3 or more diarrhea. Seventeen (53%) patients had abdominal cramps and 2 (6%) patients had rectal tenesmus. Diarrhea occurred at a median of 10 cycles. Almost all patients (29, 97%) had a correlation of diarrhoeic episodes with assumption of food, and most patients (24, 80%) reported persistent diarrhea during the rest period. Since some patients reported a worsening of diarrhea associated to fat consumption, 14 patients were advised to avoid diary products, and in 9 of them (64%) a benefit was observed. Loperamide was used in all cases, and 19 (63%) patients had a reduction of symptoms. Eleven (37%) patients had a poor control with loperamide and were treated with cholestyramine, which was effective in all cases. Nine (30%) patients had Len dose reduction, and 5 had a reduction of the diarrhea. In 19 cases Len was stopped, resulting in the rapid resolution of diarrhea in all cases. The same analysis conducted in 57 Poma-treated patients did not show any GI symptoms.
Conclusion
Adverse GI events are common in new targeted drugs, and a better understanding of the underlying physiopathological mechanism is the basis for a correct management. In particular, IMiDs have a gastrointestinal toxicity profile with peculiar characteristics for the different generations. The first-generation IMiD Thalidomide is well known to be associated with constipation, sometimes very severe. The second-generation IMiD Len has an opposed GI toxicity profile, characterized by diarrhea. In our study diarrhea is mainly mild, but still quite disturbing. However, it seems that a combination of dietary counselling, along with loperamide and cholestyramine treatment may control this symptom. On the other side, we confirm that Poma doesn't have relevant GI side effects.
Session topic: E-poster
Keyword(s): Imids, Multiple myeloma, Toxicity
Type: Publication Only
Background
Daily clinical practice in hematology is increasingly relying on novel biological drugs, with new toxicity profiles that hematologists should learn to manage. Immunomodulatory drugs (IMiDs) have a pivotal role in the treatment of multiple myeloma (MM), and are typically administered as a continuous treatment. Thalidomide is a well know constipation-inducing agent. On the contrary, physicians are aware that lenalidomide (Len) may induce gastrointestinal (GI) disorders, in particular diarrhea, but little is known of this side effect. Moreover, no specific data on GI side effects are reported on the third-generation IMiD Pomalidomide (Poma).
Aims
Description of incidence and management of diarrhea in a retrospective cohort of Len- or Poma-treated MM patients.
Methods
One hundred and twenty-six consecutive Len-treated, and 59 Poma-treated MM patients were retrospectively analyzed in terms of diarrhea occurrence. In this analysis we included Len patients consecutively treated from June 2005 to December 2015, and Poma patients consecutively treated from August 2010 to September 2015. A descriptive analysis of diarrhea incidence, onset time, and response to treatments was performed.
Results
The median age of the 126 Len-treated patients was 65 years (range 35-87); 57 (45%) received one or two autologous stem cell transplants, and 12 (10%) patients received an allogeneic stem cell transplant before Len start; 55 (44%) patients received Len as a first line therapy, 32 (25%) patients as a second line therapy, and 39 (31%) as third or subsequent line of therapy. Thirty (24%) patients had diarrhea during Len treatment. Among these patients, 27 (90%) had grade 1 diarrhea, 3 (10%) patients had grade 2 diarrhea, and no patients had grade 3 or more diarrhea. Seventeen (53%) patients had abdominal cramps and 2 (6%) patients had rectal tenesmus. Diarrhea occurred at a median of 10 cycles. Almost all patients (29, 97%) had a correlation of diarrhoeic episodes with assumption of food, and most patients (24, 80%) reported persistent diarrhea during the rest period. Since some patients reported a worsening of diarrhea associated to fat consumption, 14 patients were advised to avoid diary products, and in 9 of them (64%) a benefit was observed. Loperamide was used in all cases, and 19 (63%) patients had a reduction of symptoms. Eleven (37%) patients had a poor control with loperamide and were treated with cholestyramine, which was effective in all cases. Nine (30%) patients had Len dose reduction, and 5 had a reduction of the diarrhea. In 19 cases Len was stopped, resulting in the rapid resolution of diarrhea in all cases. The same analysis conducted in 57 Poma-treated patients did not show any GI symptoms.
Conclusion
Adverse GI events are common in new targeted drugs, and a better understanding of the underlying physiopathological mechanism is the basis for a correct management. In particular, IMiDs have a gastrointestinal toxicity profile with peculiar characteristics for the different generations. The first-generation IMiD Thalidomide is well known to be associated with constipation, sometimes very severe. The second-generation IMiD Len has an opposed GI toxicity profile, characterized by diarrhea. In our study diarrhea is mainly mild, but still quite disturbing. However, it seems that a combination of dietary counselling, along with loperamide and cholestyramine treatment may control this symptom. On the other side, we confirm that Poma doesn't have relevant GI side effects.
Session topic: E-poster
Keyword(s): Imids, Multiple myeloma, Toxicity
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