Lenalidomide Reduces Infection Mortality Rates in COVID-19-Positive Patients With Multiple Myeloma

Infection mortality rate were lower in patients with multiple myeloma who were coronavirus disease 2019 (COVID-19) positive and received maintenance lenalidomide (Revlimid) than those who did not receive lenalidomide, according to study results presented during the 2nd European Myeloma Network Meeting held virtually in March.

Further, maintenance treatment with lenalidomide was found to be a safe treatment for patients, supporting use of the immunomodulatory drug (IMiD) in this population.

Data showed that the infection mortality rate was 23.8% in patients who were COVID-19 positive and on maintenance lenalidomide compared with 33.3% for those who had COVID-19 and did not receive lenalidomide. The recovery rates in both arms were 76.2% and 66.7%, respectively.

““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 also similar mortality among [patients with multiple myeloma],” said Ekin Kircali, MD, of the Department of Hematology at Ankara University School of Medicine in Turkey, during the virtual presentation. “Based on our experience, we do not recommend discontinuation during this pandemic.”

Lenalidomide maintenance following consolidation therapy with high-dose melphalan is a common approach known to prolong progression-free survival in patients with multiple myeloma, Kircali noted in her presentation.

Lenalidomide also may induce neutropenia and lymphopenia, which in turn exposes patients to infections, including COVID-19.

However, small case series and other reports have suggested that IMiDs could protect patients from severe cases of COVID-19.

Patient Characteristics

In the study, investigators evaluated 60 patients with multiple myeloma between March 2020 and December 2020 and compared outcomes of those who received continuous lenalidomide maintenance (n = 42) vs no lenalidomide (n = 18).

Patients were divided into 3 groups: those who were COVID-19 positive and taking lenalidomide (n = 21), those who were COVID-19 negative and taking lenalidomide (n = 21), and those who were COVID-19 positive and not taking lenalidomide.

In the COVID-19–positive/lenalidomide group, the median age was 61 years (range, 57-70), and 10 patients were women. The number of lenalidomide cycles was 16 (range, 9-99), and 14 patients had a very good partial response (VGPR) or better to therapy. The neutrophil counts and lymphocyte counts were 1.43 (range, 0.74-9.2) and 0.97 (range, 0.01-2.84), respectively. IgG, IgA, and IgM levels were 7.94 mg/dL (range, 3.2-19.1), 0.69 mg/dL (range, 0.1-3.5), and 0.31 g/L (range, 0.1-0.7), respectively.

Also, in this arm, patients had either nonsevere COVID-19 (n = 15) or severe COVID-19 (n = 6), and 5 patients died. The infection fatality rate was 23.8%, and the recovery rate was 76.2%.

In the COVID-19–negative/lenalidomide group, the median age was 63 years (range, 58-71), and 11 patients were women. Sixty-one cycles (range, 10-90) of lenalidomide were given, and 18 patients had a VGPR or better to therapy. The neutrophil count was 1.65 (range, 0.77-4.24), and the lymphocyte count was 1.40 (range, 0.31-2.72). The IgG, IgA, and IgM levels were 9.46 mg/dL (range, 2.8-32.7), 1.73 mg/dL (range, 0.0-206), and 0.24 g/L (range, 0.1-0.9), respectively (TABLE1).

Within this group, 1 patient died, the infection fatality rate was 4.8%, and the recovery rate was not applicable as no patients in the group had COVID-19.

Finally, in the COVID-19–positive group without lenalidomide, the median age was 66 years (range, 46-79) and 12 patients were women. Eight patients had a VGPR or better to therapy. The neutrophil count and lymphocyte count were 3.21 (range, 0.45-67.48) and 1.03 (range, 0.03-3.81), respectively. The IgG, IgA, and IgM levels were 10.25 mg/dL (range, 2.6-113), 0.41 mg/dL (range, 0.0-2.2), and 0.26 g/dL (0.0-1.3), respectively.

In this arm, 11 patients had nonsevere COVID- 19 and 7 patients had a severe case. Six patients died; the infection fatality rate was 33.3% and the recovery rate was 66.7%.

_Reference:

_{Kircali, E, Seval GC, Toprak SK, et al. Outcome of COVID-19 infection occurring during lenalidomide maintenance. Paper presented at: 2nd European Myeloma Network Meeting; March 3-6, 2021; virtual. Abstract P34.}