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2020 ; 143
(5
): 410-416
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Multiple Myeloma in the Time of COVID-19
#MMPMID32305989
Al Saleh AS
; Sher T
; Gertz MA
Acta Haematol
2020[]; 143
(5
): 410-416
PMID32305989
show ga
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.
|*Pandemics
[MESH]
|Antineoplastic Agents/*therapeutic use
[MESH]
|Antineoplastic Combined Chemotherapy Protocols/*therapeutic use
[MESH]