ABSTRACT
Introduction: Patients with multiple myeloma (MM) have an inherently compromised humoral and cellular immunity predisposing to Covid-19 infection. Factors associated with increased risk of adverse COVID-19 outcome is unclear. The aim of our retrospective analysis was to evaluate COVID-19 infection outcome among our myeloma patients and to define the possible prognostic parameters. Patients And Methods: Between March 2020- February 2022, 10 myeloma patients were diagnosed with COVID infection confirmed by PCR test and computer tomography (CT). The severity of SARS-CoV-2 infection was classified according to WHO definition as: mild: symptomatic without pneumonia or hypoxia;moderate: with or without signs of pneumonia with SpO2 >90% on room air;severe disease: with symptoms of pneumonia and respiratory rate> 30/min, severe respiratory distress or SpO2 <90% on room air. Critical disease: with acute respiratory distress syndrome (ARDS), sepsis and septic shock. In addition, CALL (comorbidity-age-lymphocyte count-lactate dehydrogenase) score was used. All patients were given supportive care including heparin and 0.4 gr/kg/day intravenous immunoglobulin for those presenting with immunoparesis regardless of IgG treshold of 4.0 gr/L. Convalescent or monoclonal plasma was not used. All anti-myeloma treatments were discontinued until full recovery. Results: Baseline characteristics of our patients are summarized in Table 1. The median age at onset of COVID-19 was 62 years. Three patients were therapy naive, two newly diagnosed MM and one with smoldering MM. At the time point of COVID-19 diagnosis, eight patients were being followed without treatment. Twenty patients were followed out-patient without any treatment and with full recovery. Eighteen (16%) patients were admitted to ICU and 13 (12%) required invasive mechanic ventilation. Two patients received hydroxychloroquine, 68 received favipiravir, one patient received anakinra and two patients received tocilizumab. Full recovery from COVID-19 infection with regression of clinic symptoms and achievement of PCR negativity of COVID-19 was observed in 93 (84.5%) patients and 17 (15.5%) patients died due to severe COVID-19 pneumonia with respiratory and multi-organ failure. No death due to thromboembolic event was observed. As expected, high CALL risk score (HR:0.17 (95% CI: 0.06-0.48) and higher COVID severity grade (HR:0.26 (95% CI: 0.07- 0.97) were detrimental. Age did not have an impact. However response <VGPR (HR: 3.1 (95% CI: 1.0-9.6);p=0.04) or immunoparesis (HR: 6.59 (95% CI: 1.44-30.1);p=0.01) were correlated (Kappa CE: 0.212, p=0.03) and associated with worse COVID-19 outcome (Figure 1-2-3). In MVA with age, response, Call score, vaccine, immunoparesis entered in the model only immunoparesis was significant (HR: 6.5, p=0.016). Mortality prior to introduction of vaccines reduced to 3.6 % compared with 11.8 % at the pre-vaccine period. There was a trend to increase in Covid infection incidence recently due to the Omicron variant. Conclusion: Among 110 MM patients, the mortality rate is less than the one reported by IMS during the beginning of the pandemic. In our experience COVID-19 infection severity and mortality decreases with anti-Covid vaccination, response ≥VGPR or lack of immunoparesis. Importantly, MM patients with COVID-19 infection need close monitoring for severe COVID-19-related complications, and correction of humoral immunity may be life-saving. .
ABSTRACT
Introduction: Maintenance with lenalidomide after high dose melphalan consolidation is known to extend progression free survival (PFS) in multiple myeloma (MM) patients [1]. Lenalidomide may induce neutropenia and lymphopenia, exposing patients to infections. On the other hand, there have been small case series and brief reports suggesting IMIDs might protect from severe Covid-19 [2] [3]. Here, we resumed our set of MM patients who were diagnosed with Covid-19 infection and compared outcomes based on continuous lenalidomide maintenance. Patients and Methods: 45 MM patients were diagnosed with Covid- 19 in our department between March 2010- December 2020. Here we will be reporting the data of those on lenalidomide (n= 14) and not receiving Lenalidomide maintenance(n:15). Results were compared on Lenalidomide but no Covid-19 (Table 1). All statistical analyses were performed via SPSS statistics version 20.0 software. Results: Table 1 summarizes patient demographics and essential laboratory data: Infection fatality rate for lenalidomide maintenance and no lenalidomide groups were 27.5 % and 33.3 %, relatively. Recovery rates were 71.5 % and 66.7 %, relatively. Both these results were in favor of lenalidomide maintenance. Conclusion: Although cytopenias and immunoparesis may develop during continuous maintenance, lenalidomide seems to be safe and has effects in favor of less severe Covid-19 forms and mortality among MM patients. Based on our experience we do not recommend discontinuation during the pandemic.