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Shaji K. Kumar, MD
Prashant Kapoor, MD, FACP
Shaji K. Kumar, MD
Prashant Kapoor, MD, FACP
Posted: Monday, August 7, 2023
Evangelos Terpos, MD, PhD, of the University of Athens, and colleagues conducted a comprehensive survey of the updated European Myeloma Network (EMN) consensus on the management of patients with multiple myeloma in the post–COVID-19 pandemic era. Their review, which was published in the journal Leukemia, highlighted the key points that may guide clinicians in confronting the unique challenges faced by this vulnerable population.
“In [this] period, human activities have returned to normal, and COVID-19 cases are usually mild,” the investigators commented. “However, patients with multiple myeloma present an increased risk for breakthrough infections and severe COVID-19 outcomes, including hospitalization and death.”
The consensus emphasized the importance of vaccination with variant-specific boosters, such as the bivalent vaccine targeting both the ancestral Wuhan strain and Omicron BA.4 and BA.5 strains. The recommended frequency for booster administration is every 6 to 12 months after the last vaccine dose or documented COVID-19 infection. Boosters appear to counteract the negative impact of anti-CD38 monoclonal antibodies on humoral responses; however, anti–B-cell maturation antigen treatment continues to be an adverse predictive factor for humoral immune response. Evaluation of the immune response after vaccination may pinpoint a particularly vulnerable subgroup of patients who might benefit from additional boosters, prophylactic therapies, and preventive measures.
Furthermore, pre-exposure prophylaxis with tixagevimab plus cilgavimab is no longer recommended, as it has not shown to be effective against the new dominant coronavirus strains. Intravenous remdesivir and oral antivirals, such as molnupiravir and ritonavir-boosted nirmatrelvir, have demonstrated efficacy against several Omicron subvariants and should be administered in patients with multiple myeloma immediately after a positive test result or within 5 days of the onset of symptoms. In this post-pandemic era, convalescent plasma therapy has been found to hold limited significance. Patients with multiple myeloma are encouraged to continue practicing preventive measures during SARS–CoV-2 outbreaks.
Disclosure: For full disclosures of the study authors, visit nature.com.
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