P62 use of antiviral for paucisintomatic covid-19 infection in multiple myeloma patients undergoing treatment

Patients with multiple myeloma are at increased risk of mortality from COVID-19 infection and show a lower rate of sieroconversion after vaccination and usually late negativization. In this regard, some studies have shown slight changes in mortality during the post-vaccine era. COVID-19 infection, during treatment creates several issues such as discontinuation of active treatment for the disease and a rapid negativization is useful to allow early resumption of therapy. From February 2022, it is possible to set up antiviral treatment with Nirmatrelvir or Molnupiravir in paucisymptomatic patients by reducing hospitalization and evolution in more severe infection. In this study, we collect data on 75 patients with active Multiple Myeloma and COVID-19 infection from Center District (Lazio, Umbria, Marche, Abruzzo) to evaluate the efficacy of this treatment. Of 75 pts, 57 (76%) were in first line of treatment and 18 (24%) in different lines; 62 (82.6%) were treated with antivirals, specifically 49 (65%) with oral antivirals (Nirmartelvir or molnupinavir) and 14 (18.6%) with intravenous antivirals (remdesivir); the remaining 13 (17.4%) patients had no treatment. Of the 62 patients treated with antivirals, 14 (22.6%) were hospitalized for worsening general condition, and 5 (8%) died. This group of patients resolved the infection with swab negativization with a median of 10 days (range 4-72) while the 13 patients who did not undergo any antiviral treatment presented a median of negativization of 15 days. (range 5-20). The majority of patients (67/75 subjects; 89%) had been vaccinated with at least two doses of mRNA vaccine; of these, 54 patients were treated with antivirals presenting a median time to negativization of 9 days compared with 16 days for the unvaccinated and antiviral-treated (P=NS). No difference in hospitalization and mortality. Mortality from COVID-19 infection in the sample was 8% (6/75). In conclusion despite the limitations of the sample size, the use of antivirals in patients with multiple myeloma under active treatment seems to offer a more rapid negativization of the infection promoting a rapid resumption of chemotherapy treatment despite an important effect on mortality and hospitalization. A larger sample will be useful in providing further information on mortality and hospitalization in this patient setting