Recommendations for Treating Multiple Myeloma During COVID-19 Pandemic
Posted: Friday, May 1, 2020
The recent COVID-19 pandemic has created many health-care challenges, particularly for patients with multiple myeloma, who are immunocompromised and at an increased risk of infection. A report published in Acta Haematologica discussed recommendations based on clinical experience (not evidence) for managing the disease. Morie A. Gertz, MD, of the Mayo Clinic, Rochester, Minnesota, and colleagues, noted that COVID-19 screening should be performed in all patients before beginning therapy. Autologous stem cell transplantation should be delayed, except among patients with high-risk disease who are not responding well or those with ultra-high–risk disease.
The researchers did not recommend therapy for patients with smoldering multiple myeloma. For standard-risk patients, their preferred drug regimen is ixazomib, lenalidomide, and dexamethasone. However, several other drug combinations are also included in their recommendations: cyclophosphamide, lenalidomide, and dexamethasone; daratumumab, lenalidomide, and dexamethasone; lenalidomide, bortezomib, and dexamethasone; or cyclophosphamide, bortezomib, and dexamethasone. The researchers tagged carfilzomib, lenalidomide, and dexamethasone as the preferred treatment for high-risk patients. Combination treatment with lenalidomide, bortezomib, and dexamethasone may also be an option.
An important clinical question is whether or not to continue autologous stem cell transplantation during the COVID-19 pandemic. According to the investigators, the decision should be made on an individual patient basis; however, overall the surgery should be delayed among standard- or high-risk patients who are responding to therapy. Among high-risk patients who are not responding to therapy, transplantation may be considered salvage therapy, but screening for COVID-19 should be performed first.
The doses and frequency of drug administration may be modified at the discretion of the clinician and based on patient status. Patients with sustained very good partial responses or better may gradually decrease the dosage.
Disclosure: The study authors reported no conflicts of interest.
