Multiple Myeloma in the Time of COVID-19.
Antineoplastic Agents
/ therapeutic use
Antineoplastic Combined Chemotherapy Protocols
/ therapeutic use
Betacoronavirus
/ immunology
COVID-19
Clinical Decision-Making
Coronavirus Infections
/ epidemiology
Dexamethasone
/ therapeutic use
Disease Management
Hematopoietic Stem Cell Transplantation
/ methods
Humans
Lymphopenia
/ epidemiology
Multiple Myeloma
/ epidemiology
Pandemics
Pneumonia, Viral
/ epidemiology
Risk Assessment
SARS-CoV-2
Time Factors
Transplantation, Autologous
COVID-19
Multiple myeloma
Recommendations
Journal
Acta haematologica
ISSN: 1421-9662
Titre abrégé: Acta Haematol
Pays: Switzerland
ID NLM: 0141053
Informations de publication
Date de publication:
2020
2020
Historique:
received:
02
04
2020
accepted:
03
04
2020
pubmed:
20
4
2020
medline:
21
10
2020
entrez:
20
4
2020
Statut:
ppublish
Résumé
We provide our recommendations (not evidence based) for managing multiple myeloma patients during the pandemic of COVID-19. We do not recommend therapy for smoldering myeloma patients (standard or high risk). Screening for COVID-19 should be done in all patients before therapy. For standard-risk patients, we recommend the following: ixazomib, lenalidomide, and dexamethasone (IRd) (preferred), cyclophosphamide lenalidomide and dexamethasone (CRd), daratumumab lenalidomide and dexamethasone (DRd), lenalidomide, bortezomib, and dexamethasone (RVd), or cyclophosphamide, bortezomib, and dexamethasone (CyBorD). For high-risk patients we recommend carfilzomib, lenalidomide, and dexamethasone (KRd) (preferred) or RVd. Decreasing the dose of dexamethasone to 20 mg and giving bortezomib subcutaneously once a week is recommended. We recommend delaying autologous stem cell transplant (ASCT), unless the patient has high-risk disease that is not responding well, or if the patient has plasma cell leukemia (PCL). Testing for COVID-19 should be done before ASCT. If a patient achieves a very good partial response or better, doses and frequency of drug administration can be modified. After 10-12 cycles, lenalidomide maintenance is recommended for standard-risk patients and bortezomib or ixazomib are recommended for high-risk patients. Daratumumab-based regimens are recommended for relapsed patients. Routine ASCT is not recommended for relapse during the epidemic unless the patient has an aggressive relapse or secondary PCL. Patients on current maintenance should continue their therapy.
Identifiants
pubmed: 32305989
pii: 000507690
doi: 10.1159/000507690
pmc: PMC7206354
doi:
Substances chimiques
Antineoplastic Agents
0
Dexamethasone
7S5I7G3JQL
Types de publication
Journal Article
Review
Langues
eng
Sous-ensembles de citation
IM
Pagination
410-416Informations de copyright
© 2020 S. Karger AG, Basel.
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