Objective: To communicate interim guidelines to safely manage myeloma patients.
To prevent any further exposure to coronavirus disease 2019 (COVID-19), customized treatment is needed.
- Initial therapy- For initial 6- 12 cycles, use triplet therapy with bortezomib, lenalidomide and dexamethasone (RVD) followed by lenalidomide maintenance therapy for patients requiring treatment, and add bortezomib (every 2 weeks) for high risk patients.
a. Considering the cytogenetic risk and other comorbidities for elderly myeloma patients, begin with RVD or daratumumab-Rd (DRd), and if necessary, after achieving best response continue on Rd only.
- Maintenance therapy- As the risk of relapse is higher in myeloma, the treatment should not be stopped. Patients can be provided with lenalidomide, for up to 2 months at a time, along with telemedicine check-ins and in-home blood draws, as needed before starting a new cycle.
a. For high risk patients on RVD maintenance, RVD therapy should be continued, but, if necessary, it can be changed to only Rd.
b. If a patient gets COVID, it is wise to stop maintenance therapy until infection resolves.
- Minimizing visits by changing treatment- Prefer using weekly and oral regimens as prescribed by your doctor.
a. During the COVID-19 pandemic, patients on triplet drug regimen can be continued with doublet oral regimens, especially in those with stable disease and with standard risk cytogenetics.
b. Also, patients receiving bisphosphonates should be changed to zometa every 3 months. To decrease clinic visits, enable usage of remote labs, telemedicine, and prescription delivery via mail.
- Transplant-eligible patients- Stem cell transplant (including Hematopoietic stem/progenitor cell collection and storage) can be suspended during this outbreak. RVD induction therapy for 6 cycles and up to 12 cycles should be continued. However, patients already in the process, should continue with stem cell collection but the transplantation can be delayed based on both the risk of complications and issues of resource required, in the hospital setting.
Reference: COVID-19 and Multiple Myeloma: Frequently Asked Questions. Available from: https://www.hematology.org/covid-19/covid-19-and-multiple-myeloma Accessed on Apr 29, 2020.