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An Expert Opinion: Interferon and CML during the COVID-19 Pandemic

Over the last few days, reports of the possible efficacy of interferon in treating COVID have emerged.1,2 This needs some clarity for CML patients as there are different interferons.

With a long standing history of treating CML with interferon, the question has been raised as to whether patients on interferon have more resistance to COVID and even if patients are on tyrosine kinase therapy, should we be switching them to interferon.  As can be seen at other places on the iCMLf website, it is not at all clear that CML patients are more at risk for COVID than the general population or whether they will have worse outcome infections if they do get the viral infection. 
 
Secondly, as is reviewed in the papers by Talpaz et al and Cayssials et al, alpha-interferon is active against CML either alone or in combination.3,4 This is a different drug than the beta-interferon used in the Lancet studies quoted above.1,2 Beta-interferon has no significant activity against CML.  The most common use of beta-interferon has been in the therapy of multiple sclerosis. Gamma-interferon, which showed some activity against CML, has never really been put into clinical use for any disease.
 
A paper by Almeida et al, actually describes two MS patients who developed CML while on therapy with beta-interferon.5
 
In a review by Ahsan et al on the possible therapy for COVID19, a number of drugs have been discussed.6 The use of inhaled alpha-interferon in prophylaxis of corona viruses has been discussed. The idea of using this application to prevent respiratory viruses was abandoned decades ago because of convenience and cost. 
 
In summary, the beta-interferon work in the therapy of COVID-19 needs additional study but is tantalizing. By no means however, should CML patients consider interferon as an option to replace TKI therapy other than very limited indications, such as combination therapy studies, TKI intolerance or pregnancy and then only under the strict guidance of a knowledgeable physician experienced with the use of alpha-interferon.Jeff Lipton

Professor Jeff Lipton
Princess Margaret Hospital
Toronto, Canada


References

  1. Triple combination of interferon beta-1b, lopinavir-ritonavir, and ribavirin in the treatment of patients admitted to hospital with COVID-19: an open-label, randomized, phase 2 trial. Hung IF, et al Lancet. 2020 May 8. pii: S0140-6736(20)31042-4. doi: 10.1016/S0140-6736(20)31042-4. [Epub ahead of print]
  2. Interferon beta-1b for COVID-19. Shalhoub S. Lancet. 2020 May 8. pii: S0140-6736(20)31101-6. doi: 10.1016/S0140-6736(20)31101-6. [Epub ahead of print] No abstract available.
  3. The interferon-alpha revival in CML. Talpaz M, Mercer J, Hehlmann R. Ann Hematol. 2015 Apr;94 Suppl 2:S195-207. doi: 10.1007/s00277-015-2326-y. Epub 2015 Mar 27. Review
  4. Beyond tyrosine kinase inhibitors: Combinations and other agents. Cayssials E, Guilhot F. Best Pract Res Clin Haematol. 2016 Sep;29(3):271-283. doi: 10.1016/j.beha.2016.10.017. Epub 2016 Oct 20. Review.
  5. Chronic myeloid leukaemia in two multiple sclerosis patients on interferon beta-1a. Almeida L, Neves M, Cardoso E, Melo A. J Clin Pharm Ther. 2009 Feb;34(1):125-7. doi: 10.1111/j.1365-2710.2008.00983.x.
  6. Treatment of SARS-CoV-2: How far have we reached? Ahsan W, Javed S, Bratty MA, Alhazmi HA, Najmi A. Drug Discov Ther. 2020 May 6;14(2):67-72. doi: 10.5582/ddt.2020.03008. Epub 2020 Apr 25. Review.