Retrospective evaluation of immunomodulatory agents (İMİDS) response and side effects in relapsed and refractory multiple myeloma patients

Objective: Multiple myeloma is a neoplastic disease characterized by the presence of monoclonal proteins in serum and urine, end organ damage caused by these monoclonal proteins. In this study, we aimed to determine the most appropriate approaches to shape our daily practice by revealing treatment responses, side effects and side effect management of relapsed and refractory multiple myeloma patients who were treated in our clinic with IMIDs. Method: This study was carried out in Dokuz Eylul University, Section of Hematology among the patients with multiple myeloma who underwent immunomodulatory drugs (IMIDs) in one step of their treatment between June 2001 and September 2018. General characteristics, overall survival, response rates, and side effects of IMIDs. Besides we evaluate side effects profiles, prophylaxis and side effects managements used to prevent side effects. Results: The demographic data, multiple myeloma subtypes, performance status and stages of 85 patients included in the study were found to be compatible with the literature. When imaging methods were compared, MRI, CT, or PET were involved in 9 (32.1%) of the 28 patients with no bone involvement with bone survey imaging. It was found that 88.5% of the patients receiving lenalidomide treatment had at least PR response. In 5.2% of the patients, dose reduction was done due to VTE, 2.6% of the patients were discontinued the drug and 2.6% of the patients were quitted from the drug. These patients are elderly, with many comorbidities, and have higher disease activity. In patients receiving antibiotic prophylaxis, the rate of infections requiring interruption of treatment was 14.2% and this rate was found to be 58.8% in patients without prophylaxis. It was observed that 4 of 8 (50.0%) patients who had dose reduction for infectious reasons did not receive prophylaxis until dose reduction. Conclusion: IMIDs are drugs that are frequently used in RRMM and have a pronounced response. In order to use the drugs effectively, prophylactic approaches to prevent the side effects before they are developed should be determined according to patient characteristics. Key Words: Relapsed and refractory multiple myeloma, immunomodulatory drugs (IMIDs), lenalidomide, thalidomide, pomalidomide, effect, side effect