Acute Pulmonary Embolism Induced by Pomalidomide Plus Low-Dose Dexamethasone

Usage of non-ionic contrast agents in patients with multiple myeloma, who have normal creatinine level, is not high risk to develop contrast-induced nephropathy. Novel agents has improved prognosis of patients with myeloma but immunomodulatory drug-containing therapy such as lenalidomide and pomalidomide has a risk of venous thromboembolism (VTE) and pulmonary embolism (PE). Contrast-enhanced CT (CECT) is gold standard to detect PE and should be considered particularly when severe secondary complications including PE are suspected to detect and treat patients in haste if creatinine clearance level is normal. Here, we present a case presented massive pulmonary embolism on the first cycle of pomalidomide plus low-dose dexamethasone (PoMdex), which has an incident rate of 2% in all grades VTE/PE and of 1% in grade 3/4 VTE/PE. The patient has not impaired renal function since we performed CECT.