Treating Older Patients With Multiple Myeloma During the COVID-19 Pandemic
Posted: Tuesday, April 28, 2020
A report, published in the Journal of Geriatric Oncology, offered strategies for clinicians treating older patients with multiple myeloma regarding COVID-19 transmission, treatment stratification, and goals of care during this pandemic. Tanya M. Wildes, MD, MSCl, of Washington University, St. Louis, and colleagues stressed that shared decision-making and personalized treatment will be increasingly important given the challenging times. Continuing efforts to collate data are necessary for filling knowledge gaps, particularly among patient subgroups. Furthermore, building global research platforms may help mediate this pandemic and positively influence future health-care challenges among this patient population.
Limited data on the prevalence and outcomes of COVID-19 among older adults with multiple myeloma have made decision-making challenging. However, older age has been reported as a risk factor for poor prognosis in these patients. Higher numbers of comorbidities have also accounted for most of the severe cases and deaths associated with the coronavirus. Data identifying older age and disease-related vulnerabilities yield the assumption that older adults with myeloma are at an increased risk of poor outcomes if infected with COVID-19. Although more research confirming this assumption is necessary, efforts to decrease exposure in this subpopulation is critical.
According to the authors, two concepts may continue to play an important role in clinical decision-making: ‘staging the disease’ and ‘staging the aging.’ The concepts involve cytogenetics and understanding the heterogeneity of aging, respectively. Myeloma-specific frailty indices have also emerged as tools for personalizing therapy. Although these strategies were not developed specifically for COVID-19, they may help conceptualize treatment during this pandemic.
The researchers discussed considering the benefits and risks associated with the timing of therapy initiation, delaying transplant surgeries, drug regimens, supportive care systems, and clinical trials. Older adults with multiple myeloma will face difficult challenges and decisions in the upcoming months, making effective communication among caregivers, patients, and loved ones increasingly important.
Disclosure: For full disclosures of the study authors, visit sciencedirect.com.
