Managing patients with multiple myeloma during the COVID-19 pandemic

The report recommends treatment management for patients with multiple myeloma (MM) during the COVID-19 pandemic. The authors suggested that therapy should be adjusted based on risks. COVID-19 testing should be done before starting therapy.

Patients with cancer are generally older and need special care during a pandemic (a worldwide spread of a new disease). COVID-19 is a coronavirus that has emerged at the end of 2019 in China and has rapidly spread throughout the world, creating a pandemic. Those who have both cancer and COVID-19 infection are at higher risks of death or severe complications.

MM is a cancer of the immune system. Therefore, patients with MM have weak immunity and increased risks of COVID-19 infection. Treatment strategies for such patients currently require modifications.

This article issues recommendations for managing patients with MM during the COVID-19 pandemic.

Patients should be divided based on standard-risk (SR) and high-risk (HR) cancerous genetic abnormalities. Plasma cell leukemia (PCL), a severe form of MM, is ultra-HR. All patients must be tested for COVID-19 before any kind of therapy. This is mainly because MM treatment can worsen medical emergencies during COVID-19 infections. Treatment should be paused for patients testing positive until they recover from acute illness.

SR patients may be given oral drugs for reducing their hospital visits. The standard combination RVd of lenalidomide (Revlimid), bortezomib (Velcade), and dexamethasone (Decadron) is highly recommended for such patients. Bortezomib should only be given subcutaneously once a week. Dexamethasone dose should be reduced to 20 mg. Weekly hospital visits for HR patients are recommended. They have higher risks of complications from MM rather than COVID-19. Carfilzomib (Kyprolis), lenalidomide, and dexamethasone (KRd) are recommended for such patients.

Stem-cell transplants improve outcomes in patients with MM but put patients to greater risks of infection. Transplantation should be postponed for SR and HR patients with moderate to good response to traditional therapy until the pandemic improves. HR patients with poor treatment response and severe disease can be considered for a transplant.

Patients with PCL generally survive for less than a year. They should be treated with chemotherapy followed up by transplants. Relapse means MM’s return after initial therapy. Relapsing SR patients should be given daratumumab (Darzalex) based treatment but not transplants. HR patients with aggressive or fast relapse can be considered for transplants.

The report recommends treatment management for patients with multiple myeloma (MM) during the COVID-19 pandemic. 

These recommendations are based on authors’ experience but not evidence.