Tracking Rare Bowel Perforations in Patients With Multiple Myeloma
Posted: Monday, January 4, 2021
According to findings presented in Cancer Medicine, intestinal perforations rarely occur during treatment in patients with multiple myeloma. Still, they typically occur during treatment with more than 10 mg of dexamethasone per week. Urgent surgery is “life-saving,” noted Morie A. Gertz, MD, of the Mayo Clinic, Rochester, Minnesota, and colleagues, and resuming antimyeloma treatment following surgery appears to be safe.
“Perforations of the colon must be added to the list of adverse effects of multiple myeloma treatments,” the authors concluded. “Because the clinical manifestations may be obscured, abdominal complaints in multiple myeloma patients treated with steroids should be addressed seriously and promptly.”
In this retrospective study, the authors analyzed 30 patients from the Mayo Clinic with multiple myeloma who had developed colonic perforations. All patients were diagnosed with perforations based on CT scans and were surgically treated. The authors defined a high dose of dexamethasone as more than 40 mg once per week.
The authors found that all patients had received doses of steroids at more than 10 mg once per week before the perforation. Four patients (11%) were on high doses of dexamethasone without chemotherapy. In total, 14 patients were given high doses of dexamethasone, 25 patients required ostomies (with all surviving surgery), and 24 patients (80%) had perforations associated with diverticulitis. Steroid treatment resumed in 23 patients, with no additional gastrointestinal complications.
Following perforation, the median overall survival was 20 months. The authors noted that within the same time frame of their retrospective study, 5,854 patients were treated for multiple myeloma at the Mayo Clinic, suggesting the risk of bowel perforation was 0.5%.
Disclosure: For full disclosures of the study authors, visit wiley.com.