According to findings from a study presented during the 2nd European Myeloma Network Meeting held virtually in March, "Mortality rates of infection were lower in COVID-19 +Ve Patients With Multiple Myeloma and received maintenance lenalidomide than those who did not receive lenalidomide.
The lenalidomide maintenance treatment was found to be a safe treatment for patients, supporting administration of the IMiD in this group.
Findings demonstrated that the mortality rate of infection was 23.8% in COVID-19 positive patients and on maintenance lenalidomide in comparison to the 33.3% for those who had COVID-19 and were not given lenalidomide. In both arms, the recovery rates were noted as 76.2% and 66.7%, respectively.
During a virtual presentation, Ekin Kircali, MD, of Department of Hematology at Ankara University School of Medicine in Turkey, said that, “Although cytopenias and immunoparesis may develop while on continuous maintenance, lenalidomide appears to be safe and has effects in the favor of less severe forms of COVID-19 and also identical mortality among MM patients.”
“On behalf of our experience, we do not recommend the discontinuation during this pandemic,” Ekin Kircali added.
Lenalidomide maintenance after consolidation therapy together with high-dose melphalan is a common approach known to prolong PFS in MM patients, Kircali noted in her presentation.
Lenalidomide also can induce neutropenia as well as lymphopenia, which in turn exposes patients to infections, including COVID-19. Although, small case series and other reports have demonstrated that IMiDs could prevent severe cases of the COVID-19.
In a respective carried out study, investigators assessed a total of 60 MM patients between March 2020 and December 2020 and compared findings of those who were given continuous lenalidomide maintenance (n = 42) versus no lenalidomide (n = 18).
Patients were splitted into three groups: those who were COVID-19 +Ve and were given lenalidomide (n = 21), those patients who were COVID-19 -Ve and were given lenalidomide (n = 21), and those patients who were COVID-19 +Ve and not taking lenalidomide.
In the COVID-19+Ve/lenalidomide population, the median age was noted as 61-years (range, 57 to 70), and 10 enrolled patients were women. The number of lenalidomide cycles was 16 (range, 9 to 99), and 14-patients had VGPR/better to the therapy.
Count of neutrophils and lymphocytes were noted as 1.43 (range, 0.74 to 9.2) and 0.97 (range, 0.01 to 2.84), respectively. Levels of IgG, IgA, and IgM were 7.94 mg/dL (range, 3.2 to 19.1), 0.69 mg/dL (range, 0.1 to 3.5), and 0.31 g/L (range, 0.1 to 0.7), respectively.
In addition, in this arm, patients had either nonsevere COVID-19 (n = 15) or severe COVID-19 (n = 6), and 5 patients reported dead. The rate of infection fatality was noted as 23.8%, and the rate of recovery was noted as 76.2%.
In the COVID-19 -Ve/lenalidomide population, the median age was noted as 63-years (range, 58 to 71), and enrolled 11-patients were the women. 61-cycles (range, 10 to 90) of lenalidomide were given, and 18-patients had a VGPR/better to the therapy.
The count of neutrophil was noted as 1.65 (range, 0.77 to 4.24), and the count of lymphocytes was noted as 1.40 (range, 0.31 to 2.72). Levels of IgG, IgA, and IgM were 9.46 mg/dL (range, 2.8 to 32.7), 1.73 mg/dL (range, 0.0 to 206), and 0.24 g/L (range, 0.1 to 0.9), respectively.
Within this population, 1-patient died, the rate of infection fatality was noted as 4.8%, and the rate of recovery was inapplicable as no patients in the population had COVID-19.
At the end, in the COVID-19 +Ve population without lenalidomide, the median age was noted as 66-years (range, 46 to 79) and enrolled 12-patients were women. 8-patients had a VGPR/better to the therapy.
Count of neutrophils and lymphocytes were noted as 3.21 (range, 0.45 to 67.48) and 1.03 (range, 0.03 to 3.81), respectively. Levels of IgG, IgA, and IgM were noted as 10.25 mg/dL (range, 2.6 to 113), 0.41 mg/dL (range, 0.0 to 2.2), and 0.26 g/dL (0.0 to 1.3), respectively.
In this arm, eleven patients had nonsevere COVID- 19 and seven patients had a severe case. Total of 6-patients died; and the rate of infection fatality was noted as 33.3% and the rate of recovery was noted as 66.7%.
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