Immunomodulatory drugs (IMiDs) such as thalidomide, lenalidomide, and pomalidomide are integral to multiple myeloma (MM) treatment, improving survival and quality of life. Thalidomide often causes neuropathy and sedation, lenalidomide increases risks of thromboembolism and secondary malignancies, and pomalidomide—used in relapsed/refractory MM—primarily causes hematologic toxicities like neutropenia and anemia. Pomalidomide has a lower venous thromboembolism risk than other IMiDs, likely due to more frequent prophylaxis, but infections and fatigue remain common. Real-world data confirm these trends, underscoring the importance of early recognition and management of adverse events (AEs) to maintain treatment adherence and efficacy. 

Effective management of pomalidomide-related AEs includes monitoring, dose adjustments, and supportive care like antivirals, growth factors, and thromboembolism prophylaxis. Case studies show how treatment can be personalized for patients with cytopenias, renal impairment, or socioeconomic challenges. New agents, such as cereblon E3 ligase modulator agents, offer promising efficacy with manageable safety profiles. Despite their structural similarities, IMiDs differ in tolerability, requiring tailored approaches to optimize outcomes. With expanding treatment options in relapsed MM, balancing efficacy with AE management is essential to sustain quality of life and long-term disease control.

Reference: Nadeem O, Ailawadhi S, Khouri J, et al. Management of Adverse Events Associated with Pomalidomide-Based Combinations in Patients with Relapsed/Refractory Multiple Myeloma. Cancers (Basel). 2024;16(5):1023. doi: 10.3390/cancers16051023.