Objective: To communicate interim guidelines to safely manage multiple myeloma patients
To prevent any further exposure to coronavirus disease of 2019 (COVID-19), customized treatment is needed for management of multiple myeloma patients:
1. In initial therapy- For 6- 12 cycles, use triplet therapy with bortezomib, lenalidomide and dexamethasone (RVD) followed by maintenance therapy using lenalidomide for patients requiring treatment, and bortezomib (every 2 weeks) can be added for high risk patients. Elderly myeloma patients could start with RVD or daratumumab-Rd (DRd) depending on cytogenetic risk and other comorbidities, and can be continued on Rd only after achieving best response.
2. In maintenance therapy- As the risk of relapse is higher in myeloma, the treatment should not be stopped. Patients should continue using 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. If a patient gets COVID-19, it is wise to intrude maintenance therapy until infection resolves. For high risk patients on RVD maintenance, RVD therapy should be continued, but, if necessary, it can be changed to only lenalidomide plus dexamethasone.
3. Try to minimize visits by changing treatment- Use weekly and oral regimens. 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.
4. Zoledronic acid-. The frequency of dosing should be changed to every 3 months or bisphosphonates class of drugs can be held during the pandemic. To decrease clinic visits, enable usage of remote labs, telemedicine, and prescription delivery via mail.
Reference: COVID-19 and Multiple Myeloma: Frequently Asked Questions. Available from: https://www.hematology.org/covid-19/covid-19-and-multiple-myeloma Accessed May 1, 2020