Multiple myeloma and therapeutic decisions during COVID-19

Best Practice Nordic | Kesä 2020 | COVID-19 |

Patients with multiple myeloma (MM) could be in an increased risk of a more severe COVID-19 infection and of more severe associated complications. In this COVID-19 perspective, associate professor Annette Juul Vangsted goes through newly made clinical guidelines during the COVID-19 pandemic created by The European Myeloma Network.  Multiple myeloma is an incurable cancer in the plasma cell with overproduction of a dysfunctional immunoglobulin. The disease is located in the bone marrow and at diagnosis it can present with osteolytic lesions of the bone, hypercalcemia, marrow suppression, renal impairment and infections which all require immediate treatment. The disease by itself causes a dysfunctional cellular and innate immune function and most of the treatment available also render the patients prone of serious infections due to hematological toxicity. Finally, most patients with multiple myeloma are older and patients with multiple myeloma seems at risk of more severe COVID-19 infections and complications. General precautions Patient education with focus on personal hygiene and physical distancing are recommended as well as consultation by telemedicine. Blood examinations at smaller local laboratories are recommended to avoid contact to hospitals with more patients. At necessary visits at the clinic, patient and health professional are recommended to wear face protections. Frequent testing of myeloma patient for SARS-CoV-2 is recommended before admission to hospitals, at new treatment line, leukapheresis and autologous hematopoietic stem cell transplantation (ASCT). Treatment Watchful waiting should be considered but treatment should not be delayed for patients with end organ damage, acute situation ex. renal impairment, hypercalcemia and medullary compression syndrome and in patients with aggressive relapse. Individualized treatment with oral-based treatment should be considered. Reduced doses of dexamethasone and de-intensified regimes with proteasome inhibitors given once weekly (bortezomib, carfilzomib) and daratumumab given once monthly is recommended when possible in accordance to response to treatment. For patients...