Colon perforation in multiple myeloma patients – A complication of high-dose steroid treatment

Iuliana Vaxman, Abdullah S. Al Saleh, Shaji Kumar, Mishra Nitin, Angela Dispenzieri, Francis Buadi, David Dingli, Martha Lacy, Eli Muchtar, Miriam Hobbs, Amie Fonder, Lisa Hwa, Alissa Visram, Prashant Kapoor, Mustaqeem Siddiqui, John Lust, Robert Kyle, Vincent Rajkumar, Suzanne Hayman, Nelson LeungWilson Gonsalves, Taxiarchis Kourelis, Rahma Warsame, Morie A. Gertz*

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

2 Scopus citations


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.

Original languageEnglish
Pages (from-to)8895-8901
Number of pages7
JournalCancer Medicine
Issue number23
StatePublished - Dec 2020


FundersFunder number
National Cancer InstituteP50CA186781
Division of Cancer Prevention, National Cancer Institute5P50 CA186781-04


    • colostomy
    • diverticulitis
    • intestinal
    • multiple myeloma
    • perforation


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