Oral domiciliary therapy of multiple myeloma with cyclophosphamide, pomalidomide and dexamethasone regimen in the covid era: A pilot study

ABSTRACT

Aims & Objectives: Aim: To observe the feasibility and efficacy of domiciliary, oral treatment with cyclophosphamide, pomalidomide and dexamethasone (Cy-Pom-Dex) for myeloma patients during the COVID-19 pandemic. Objectives: • To observe the feasibility of Cy-Pom-Dex for the treatment of newly diagnosed and relapsed myeloma patients. • To assess the therapeutic efficacy of the same. Patients/Materials & Methods: Type of study Prospective, observational, single-arm, pilot study Study period from 1st March to 30th September 2020. Study methodology: Patients who had newly-diagnosed or relapsed multiple myeloma during the above-mentioned time period at a tertiary care Centre in Bengaluru were started on oral treatment with Cy-Pom-Dex during the lockdown mandated by the COVID-19 pandemic. This regimen was chosen as a replacement for cyclophosphamide-bortezomib-dexamethasone (CyBorD), which was the previous standard of care in our Centre. Dosage of the regimen Cyclophosphamide 400 mg PO on days 1,8 and 15;Pomalidomide 4 mg PO from days 1 to 21;Dexamethasone 40 mg PO/20 mg PO on days 1,8,15 and 22;Cycle was repeated every 28 days. Haematological and biochemical parameters of the patients were checked pretreatment. Weekly complete blood counts and biochemistry was checked with home collection of blood samples. This was combined with weekly video consultations. Face-to-face visits were conducted on a monthly basis and myeloma parameters were checked at the end of every 2 months. Results: Out of 6 myeloma patients during the above-mentioned study period, 4 (66.67%) had IgG kappa, 1(16.67%) had IgA kappa and 1(16.67%) IgG lamda myeloma. 2 (33.33%) had ISS stage II disease and 4 (66.67%) ISS-III. 2 (33.33%) patients were newly diagnosed and received Cy-Pom-Dex from the first cycle, while 2 (33.33%) had hypercalcemia and renal failure at diagnosis,hence were given CyBorD as the first cycle which was then followed by Cy-Pom-Dex from the second cycle. 2 (33.33%) patients received Cy-Pom-Dex for remission induction for relapse, post-autologous stem cell transplant. 1 patient who had received Cy-Pom-Dex from the first cycle was lost to follow-up (COVID-19 positive). Among the remaining 5 patients, 4 (80%) achieved VGPR after 4 cycles and the last patient (20%) achieved sCR. All the patients were subsequently started on lenalidomide maintenance. Discussion & Conclusion: Domiciliary treatment was feasible in all of our patients. This regimen achieved good disease control in all the evaluable patients, within 4 cycles. Larger number of patients is however required to draw definitive conclusions.