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Colon perforation in multiple myeloma patients – A complication of high‐dose steroid treatment
- Source :
- Cancer Medicine
- Publication Year :
- 2020
- Publisher :
- Wiley, 2020.
-
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.<br />Colon perforations are rare in MM and here we report characteristics and clinical outcomes of 30 patients that were treated at Mayo Clinic. We believe that steroids are the precipitating factor.
- Subjects :
- Male
colostomy
0301 basic medicine
Cancer Research
Constipation
medicine.medical_treatment
Dexamethasone
Diverticulitis, Colonic
Colonic Diseases
0302 clinical medicine
Risk Factors
perforation
Medicine
Original Research
Aged, 80 and over
intestinal
Middle Aged
Diverticulitis
multiple myeloma
Treatment Outcome
Oncology
030220 oncology & carcinogenesis
Female
Steroids
medicine.symptom
medicine.drug
Adult
medicine.medical_specialty
Nausea
Perforation (oil well)
Risk Assessment
03 medical and health sciences
AL amyloidosis
Humans
Radiology, Nuclear Medicine and imaging
Aged
Retrospective Studies
Chemotherapy
business.industry
Clinical Cancer Research
medicine.disease
United States
Surgery
diverticulitis
030104 developmental biology
Intestinal Perforation
Tomography, X-Ray Computed
business
Complication
Subjects
Details
- ISSN :
- 20457634
- Volume :
- 9
- Database :
- OpenAIRE
- Journal :
- Cancer Medicine
- Accession number :
- edsair.doi.dedup.....730bcafaabcaa3ed393a2749897eea30