Myeloma and COVID-19: Consensus on Management From European Myeloma Network
Posted: Tuesday, September 1, 2020
The European Myeloma Network has presented an expert consensus statement in the journal Leukemia offering guidance on making therapeutic decisions for patients with multiple myeloma during the current COVID-19 pandemic. The need for polymerase chain reaction (PCR) swab tests prior to patient hospital admission and new treatment as well as the participation of health-care providers in international registries collecting data about patients with myeloma who have COVID-19 infection are among the recommendations outlined by Pieter Sonneveld, MD, PhD, of the Erasmus MC Cancer Institute, Rotterdam, The Netherlands, and colleagues.
“Recommendations must be updated and revisited frequently, when data will be more mature regarding registry analyses and with more knowledge regarding the impact of various antimyeloma therapy on COVID-19,” the authors commented.
The authors noted, it has been shown that patients with myeloma receiving immunomodulatory drugs and proteasome inhibitors are at an increased risk of severe COVID-19 infections. These patients also tended to be older and have more age-related comorbidities.
Thus, the authors recommended that in countries where COVID-19 infections are widely spreading, patients with myeloma should undergo PCR tests before hospital admission and before starting a new treatment line, cell apheresis, or autologous stem cell transplantation. Oral agent-based regimens should be considered for all elderly and frail patients with standard-risk disease, where de-intensified regimens of dexamethasone, bortezomib, carfilzomib, and daratumumab should be used based on patient risk and response, they noted.
For patients with end-organ damage, myeloma emergencies, and aggressive relapse, treatment initiation should not be postponed, according to the guidelines. However, transplantation should be delayed and extended induction administered. For patients with myeloma and symptomatic COVID-19, myeloma treatment should be interrupted until recovery of the infection. For asymptomatic patients with COVID-19, a 14-day quarantine should be considered if myeloma-related events allow such delay in treatment.
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