Clinical characteristics and risk factors for pomalidomide-induced skin rash: Implications for pharmacist-led monitoring in real-world multiple myeloma care

BackgroundPomalidomide (POM) can cause skin rash, although it is generally considered less frequent than lenalidomide (LEN)-induced rash. However, skin rash remains a clinically relevant adverse event that may lead to treatment interruption in patients with multiple myeloma. This study aimed to identify clinical risk factors for POM-induced skin rash.MethodsWe retrospectively analyzed 76 patients who received POM-containing regimens between 2015 and 2022. The incidence, severity, and timing of skin rash were evaluated. Clinical variables were compared between patients with and without POM-induced skin rash, and multivariate logistic regression was performed to identify independent risk factors.ResultsPOM-induced skin rash occurred in 22.4% of patients, with 17.1% experiencing Grade ≥2 rash. Treatment interruption due to rash occurred in 4 patients. A history of LEN-induced skin rash (p = 0.025) and no recent proteasome inhibitor exposure (p = 0.038) were identified as independent risk factors for POM-induced skin rash.ConclusionPatients with a prior history of LEN-induced skin rash or with long intervals since proteasome inhibitor exposure are at increased risk for POM-induced skin rash. Pharmacists should identify these high-risk patients before initiating POM therapy and implement early monitoring and supportive care to prevent unnecessary treatment interruption.