Pomalidomide is an immunomodulatory agent primarily used for the treatment of multiple myeloma, with specific indications and strict medication precautions. The following will explain from two aspects: indications and medication precautions, covering treatment conditions, dosage regimens, and special risk management.

1. Indications

(1) Relapsed refractory multiple myeloma: Used in combination with dexamethasone to treat adult patients who have previously received at least two treatment regimens (including lenalidomide and proteasome inhibitors) for disease progression.

(2) HIV related Kaposi sarcoma: applicable to AIDS patients who do not respond to highly effective antiretroviral treatment.

2. Medication precautions

(1) Pregnancy risk management

It has teratogenicity, and pregnancy status needs to be confirmed before medication. Women of childbearing age must adopt two types of contraception, continuous contraception during treatment and within 4 weeks after discontinuation of medication.

(2) Hematological toxicity monitoring

Neutrophil count needs to be monitored weekly. Medication should be temporarily suspended for grade 3 neutropenia and permanently discontinued for grade 4. Patients with thrombocytopenia need to adjust their dosage.

(3) Prevention of venous thrombosis

All patients need to receive thromboprophylaxis treatment, and low-molecular-weight heparin is recommended for high-risk patients. Thrombotic events require discontinuation of medication and evaluation.

(4) Medication for special populations

Liver dysfunction: Mild damage does not require adjustment, moderate to severe damage requires a reduction of 25% -50%. Renal insufficiency: creatinine clearance rate ≥ 30mL/min does not need to be adjusted, and below 30mL/min, it needs to be reduced by 50%.

(5) Drug interactions

Strong CYP1A2 inhibitors can increase the blood concentration of pomalidomide and should be avoided in combination. When used in combination with digoxin, blood drug concentration needs to be monitored.