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Colon perforation in multiple myeloma patients - A complication of high-dose steroid treatment.
Vaxman, Iuliana; Al Saleh, Abdullah S; Kumar, Shaji; Nitin, Mishra; Dispenzieri, Angela; Buadi, Francis; Dingli, David; Lacy, Martha; Muchtar, Eli; Hobbs, Miriam; Fonder, Amie; Hwa, Lisa; Visram, Alissa; Kapoor, Prashant; Siddiqui, Mustaqeem; Lust, John; Kyle, Robert; Rajkumar, Vincent; Hayman, Suzanne; Leung, Nelson; Gonsalves, Wilson; Kourelis, Taxiarchis; Warsame, Rahma; Gertz, Morie A.
Affiliation
  • Vaxman I; Division of Hematology, Mayo Clinic, Rochester, MN, USA.
  • Al Saleh AS; Institute of Hematology, Davidoff Cancer Center, Rabin Medical Center, Petah-Tikva, Israel.
  • Kumar S; Sackler Faculty of Medicine Tel-Aviv University, Tel-Aviv, Israel.
  • Nitin M; Division of Hematology, Mayo Clinic, Rochester, MN, USA.
  • Dispenzieri A; King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia.
  • Buadi F; Division of Hematology, Mayo Clinic, Rochester, MN, USA.
  • Dingli D; Division of Colon and Rectal Surgery, Mayo Clinic, Scottsda, AZ, USA.
  • Lacy M; Division of Hematology, Mayo Clinic, Rochester, MN, USA.
  • Muchtar E; Division of Hematology, Mayo Clinic, Rochester, MN, USA.
  • Hobbs M; Division of Hematology, Mayo Clinic, Rochester, MN, USA.
  • Fonder A; Division of Hematology, Mayo Clinic, Rochester, MN, USA.
  • Hwa L; Division of Hematology, Mayo Clinic, Rochester, MN, USA.
  • Visram A; Division of Hematology, Mayo Clinic, Rochester, MN, USA.
  • Kapoor P; Division of Hematology, Mayo Clinic, Rochester, MN, USA.
  • Siddiqui M; Division of Hematology, Mayo Clinic, Rochester, MN, USA.
  • Lust J; Division of Hematology, Mayo Clinic, Rochester, MN, USA.
  • Kyle R; Division of Hematology, Mayo Clinic, Rochester, MN, USA.
  • Rajkumar V; Division of Hematology, Mayo Clinic, Rochester, MN, USA.
  • Hayman S; Division of Hematology, Mayo Clinic, Rochester, MN, USA.
  • Leung N; Division of Hematology, Mayo Clinic, Rochester, MN, USA.
  • Gonsalves W; Division of Hematology, Mayo Clinic, Rochester, MN, USA.
  • Kourelis T; Division of Hematology, Mayo Clinic, Rochester, MN, USA.
  • Warsame R; Division of Hematology, Mayo Clinic, Rochester, MN, USA.
  • Gertz MA; Division of Hematology, Mayo Clinic, Rochester, MN, USA.
Cancer Med ; 9(23): 8895-8901, 2020 12.
Article in En | MEDLINE | ID: mdl-33022868
ABSTRACT
Gastrointestinal complications of multiple myeloma (MM) treatment are common and include nausea, constipation, and diarrhea. However, acute gastrointestinal events like perforations are rare. We aimed to describe the characteristics and outcomes of patients with MM that had colonic perforations during their treatment. This is a retrospective study that included patients from all three Mayo Clinic sites who had MM and developed a colonic perforation. All patients were diagnosed with colonic perforations based on CT scans and were surgically treated. Patients diagnosed with AL amyloidosis, a perforated colon complicating neutropenic colitis during ASCT and those with perforation due to colonic cancer were excluded. A high dose of dexamethasone was defined as ≥40 mg dexamethasone once a week. Thirty patients met inclusion criteria. All patients received steroids at doses ≥10 mg once weekly prior to the perforation, while four (11%) were on high-dose dexamethasone without chemotherapy. Fourteen patients were given high doses of dexamethasone. Twenty-five patients required ostomies with all surviving surgery. Twenty-four perforations (80%) were associated with diverticulitis. Treatment with steroids was resumed in 23 patients with no further gastrointestinal complications. The median OS was 20 months following perforation (IQR 8-59). Within the same timeframe 5854 patients were treated at Mayo Clinic for MM, making the risk of bowel perforation 0.5%. Intestinal perforations in MM are rare and, in our series, always occurred with dexamethasone ≥10 mg per week. Urgent surgery is lifesaving and resumption of anti-myeloma treatment appears to be safe.
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Full text: 1 Collection: 01-internacional Database: MEDLINE Main subject: Steroids / Dexamethasone / Colonic Diseases / Intestinal Perforation / Multiple Myeloma Type of study: Etiology_studies / Observational_studies / Risk_factors_studies Limits: Adult / Aged / Aged80 / Female / Humans / Male / Middle aged Country/Region as subject: America do norte Language: En Journal: Cancer Med Year: 2020 Document type: Article Affiliation country: Estados Unidos

Full text: 1 Collection: 01-internacional Database: MEDLINE Main subject: Steroids / Dexamethasone / Colonic Diseases / Intestinal Perforation / Multiple Myeloma Type of study: Etiology_studies / Observational_studies / Risk_factors_studies Limits: Adult / Aged / Aged80 / Female / Humans / Male / Middle aged Country/Region as subject: America do norte Language: En Journal: Cancer Med Year: 2020 Document type: Article Affiliation country: Estados Unidos