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Introduction: Recent studies have shown an increased risk of covid infections in patients with multiple myeloma (MM) compared to patients withoutMM, a reduction in the number of new diagnoses ofMMin 2020 compared to 2019 as well as a decrease in the survival of newly diagnoses patients. The general objective of this study was to analyze the possible impact of covid-19 pandemic in the treatment plan for patients withMM who are candidates for autologous hematopoietic stem cell transplantation (HSCT). Material(s) and Method(s): All patients with MM who received autologous HSCT in our hospital between March 2020 and October 2021 has been included in the study. This period coincides with the beginning of the confinement for covid-19 in our country and the date of which 88,4% of the population over 12 years of age had received the complete vaccination schedule at that time according to official data. Patient demographics, disease-related variables were obtained from the patient's medical record. On the other hand, treatment-related variables were collected from the eprescription program. Results and discussion: A total of 13 patients were undergoing induction treatment or underwent autologous HSCT during the study period, 62% were men. The median age of the patients was 55 years (30-69). Almost all patients (92,3%) were affected in some way the planned treatment. The reasons were the following: the induction treatment had to be prolonged in 5 patients (increase in the number of cycles due to the impossibility of performing the HSCT), in 4 patients the induction treatment had to be changed (bortezomib/lenalidomide/dexamethasone for bortezomib/ thalidomide/dexamethasone) due to the impossibility of performing apheresis as planned after the third cycle, 2 patients had delay in starting second-line treatment after disease relapse or in starting consolidation treatment and 1 patient suffered a delay in the diagnosis of relapse (delay in the planned CT scan confirming progression). Conclusion(s): Although we cannot yet know the impact on survival, the covid-19 pandemic has meant an alteration in the treatment plan of practically all myeloma patients who are candidates for HSCT and who were receiving anti-myeloma therapy in our hospital in the first 18 months after the declaration of the pandemic in our country.
ABSTRACT
Background and importanceRemdesivir is a viral RNA polymerase inhibitor. After the NIAID ACTT-1 study results, it currently is an antiviral medicine used to treat coronavirus disease 2019.Aim and objectivesDescribe use of remdesivir based on current epidemiological trends.Describe results of use of remdesivir in clinical practice.Compare our research results with those of the NIAD ATCC-1 study.Material and methodsRetrospective observational study, all patients treated with remdesivir were included for two study periods: first stage (July–December 2020) and second stage (January–March 2021). Demographic and clinical variables were collected. Data were obtained from electronic medical records and prescription applications. Nineteen patients were included in the study.ResultsAt the beginning (n (%)) 1st stage (n=14) 2nd stage (n=5) Median age (years) 57.2 56.8 Sex Female 5 (35.7) 2 (40) Male 9 (64.3) 3 (60) Prescription ICU 6 (43) 1 (20) No ICU 8 (57) 4 (80) Charlson Comorbidity Index 2.94 2.90 Symptom days 6.1 5.9 Days of treatment 5 5 Treated with dexamethasone 10 (71.4) 4 (80) Oxygen saturation 90.7 92.6 Respiratory support 14 (100) 3 (60) Type of respiratory support Vmask (30–60%) 3 (21,4) 1 (20) Nasal prongs 11 (78,6) 2 (40) Total admission days 11.5 10 At 28 days (n (%)) 1st stage (n=14) 2nd stage (n=5) Respiratory support 3 (21.4) 0 (0) Died 1 (7.14) 0 (0) Not hospitalised 9 (64.3) 5 (100) Conclusion and relevanceIn both stages remdesivir was used in a similar way in patients with similar basal characteristics. Treatment days were 5, instead of 10 days as in the pivotal study, due to regulation of Spanish health officials’ instructions in patients who did not require mechanical ventilation.Patients treated with remdesivir presented a recovery time with an average of 11.5 and 10 days, respectively. These data matched those of the previous study.Similar to previous research, lack of a control group and the small sample size must be mentioned, and because of this the magnitude of clinical benefit could not be estimated.References and/or acknowledgementsConflict of interestNo conflict of interest
ABSTRACT
Background and importance Tocilizumab is an anti-human IL-6 receptor monoclonal antibody used in the treatment of cytokine release syndrome in patients with pneumonia associated with coronavirus disease. Despite the data from the COVACTA study, tocilizumab continues to be the gold standard for patients in our centre. Aim and objectives To describe the use of tocilizumab in the first peak versus the second peak of the SARS-CoV-2 pandemic, and to describe the results of the use of tocilizumab in both situations. Material and methods All patients treated with tocilizumab were included in the study periods: first peak (March to June 2020) and second peak (August to the present 2020). Demographic and clinical variables were collected. Data were obtained from the electronic medical records and prescription applications. Results 65 patients were included, 36 patients (55.38%) in the first peak versus 29 patients (44.62%) in the second peak. Conclusion and relevance In the first peak, tocilizumab was prescribed to more serious patients: those admitted to the ICU, with a higher FINE score and needing aggressive support therapy. In addition, it was prescribed in patients with a higher D-dimer. Doses and number of administrations were higher in the first peak. New scientific evidence led to the use of different concomitant treatments in the second peak: corticosteroids (second peak dexamethasone versus first peak methylprednisolone) and antiviral therapy (only remdesivir in the second peak). In the second peak, hospital and ICU stays were shorter, probably because tocilizumab was used in less serious patients. Despite this, no differences in mortality were observed. A study limitation was sample size (Table Presented).