Impact of the COVID-19 pandemic on treatment approaches of multiple myeloma
Main Article Content
Abstract
Cancer has been recognized as one of the major comorbidities associated with severe outcomes in the novel coronavirus disease 19 (COVID-19) patients. Compared to those with solid tumors and those without cancer, patients with hematologic malignancies appear to have more severe clinical outcomes and higher rate of mortality from COVID-19. This was particularly demonstrated during the early pandemic period. The COVID-19 pandemic has posed additional challenges in the management of hematologic malignancies, including establishing prompt diagnoses, providing optimal treatment while minimizing the risk and sequela of COVID-19 infection. Given these challenges, clinical practice guidelines and recommendations on management of hematologic malignancies during the COVID-19 pandemic were developed and proposed based on expert panels and individual expert opinions. Multiple myeloma is the second most common hematologic malignancy. The management of patients with multiple myeloma during the COVID-19 pandemic is extremely challenging as patients with multiple myeloma are particularly vulnerable to infections due to underlying humoral and cellular immune dysfunction, cytotoxic chemotherapy, immunotherapy, cellular therapy and steroid regimens, advanced age, and the presence of other comorbidities. In this paper, we attempt to provide a general review of clinical practice management patterns during and after the COVID-19 pandemic in patients with multiple myeloma and demonstrate how changes evolved as more knowledge was gained over time. Specifically, we review the impact of the pandemic on treatment approaches, supportive care, and vaccinations for patients with newly diagnosed multiple myeloma, relapsed/refractory multiple myeloma, patients with stable disease, and those with precursor states like monoclonal gammopathy and smoldering multiple myeloma. During early pandemic several changes were noted in myeloma care including minor delay in time to treatment initiation and tendency to defer autologous stem cell transplant. However, after 2022, with the advent of effective vaccines and treatment strategies the severity of COVID-19 infection decreased and care of myeloma returned to usual management, incorporating transplant, CART and multiple novel immune therapy approaches. Finally, we highlight the importance of meticulous vaccination schedule for patients with myeloma for all common viral, bacterial pathogens and vaccination against COVID-19.
Keywords:
COVID-19, COVID-19 pandemic, Impact of the COVID-19 pandemic, treatment approaches, myeloma
Article Details
How to Cite
THEPRUNGSIRIKUL, Poy; NEPARIDZE, Natalia.
Impact of the COVID-19 pandemic on treatment approaches of multiple myeloma.
Medical Research Archives, [S.l.], v. 11, n. 6, june 2023.
ISSN 2375-1924.
Available at: <https://esmed.org/MRA/mra/article/view/3912>. Date accessed: 29 apr. 2024.
doi: https://doi.org/10.18103/mra.v11i6.3912.
Section
Review Articles
The Medical Research Archives grants authors the right to publish and reproduce the unrevised contribution in whole or in part at any time and in any form for any scholarly non-commercial purpose with the condition that all publications of the contribution include a full citation to the journal as published by the Medical Research Archives.
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3. El-Sharkawi D, Iyengar S. Haematological cancers and the risk of severe COVID-19: exploration and critical evaluation of the evidence to date. Br J Haematol. 2020;190(3):336-345. doi:10.1111/bjh.16956
4. Erdal GS, Polat O, Erdem GU, et al. The mortality rate of COVID-19 was high in cancer patients: a retrospective single-center study. Int J Clin Oncol. 2021;26(5):826-834. doi:10.1007/s10147-021-01863-6
5. Liang W, Guan W, Chen R, et al. Cancer patients in SARS-CoV-2 infection: a nationwide analysis in China. Lancet Oncol. 2020;21(3):335-337. doi:10.1016/S1470-2045(20)30096-6
6. Meng Y, Lu W, Guo E, et al. Cancer history is an independent risk factor for mortality in hospitalized COVID-19 patients: a propensity score-matched analysis. J Hematol Oncol. 2020;13(1):75. doi:10.1186/s13045-020-00907-0
7. Saini KS, Tagliamento M, Lambertini M, et al. Mortality in patients with cancer and coronavirus disease 2019: a systematic review and pooled analysis of 52 studies. Eur J Cancer. 2020;139:43-50. doi:10.1016/j.ejca.2020.08.011
8. He W, Chen L, Chen L, et al. COVID-19 in persons with haematological cancers. Leukemia. 2020;34(6):1637-1645. doi:10.1038/s41375-020-0836-7
9. Langerbeins P, Hallek M. COVID-19 in patients with hematologic malignancy. Blood. 2022; 140(3):236-252. doi: 10.1182/blood.2021012251
10. Kyle RA, Rajkumar SV. Multiple myeloma. N Engl J Med. 2004;351:1860-1873. doi:10.1056/NEJMra041875
11. Palumbo A, Anderson K. Multiple myeloma. N Engl J Med. 2011;364:1046-1060. doi:10.1056/NEJMra1011442
12. van de Donk NWCJ, Pawlyn C, Yong KL. Multiple myeloma. Lancet. 2021;397(10272): 410-427. doi:10.1016/S0140-6736(21)00135-5
13. Rajkumar SV. Multiple myeloma: 2022 update on diagnosis, risk stratification, and management. Am J Hematol. 2022;97(8):1086-1107. doi:10.1002/ajh.26590
14. Siegel RL, Miller KD, Fuchs HE, Jemal A. Cancer statistics, 2022. CA Cancer J Clin. 2022;72(1):7-33. doi:10.3322/caac.21708
15. Hultcrantz M, Richter J, Rosenbaum CA, et al. COVID-19 infections and clinical outcomes in patients with multiple myeloma in New York City: a cohort study from five academic centers. Blood Cancer Discov. 2020;1(3):234-243. doi:10.1158/2643-3230.BCD-20-0102
16. Al Saleh AS, Sher T, Gertz MA. Multiple myeloma in the time of COVID-19. Acta Haematol. 2020;143(5):410-416. doi:10.1159/000507690
17. Martínez-López J, Mateos MV, Encinas C, et al. Multiple myeloma and SARS-CoV-2 infection: clinical characteristics and prognostic factors of inpatient mortality. Blood Cancer J. 2020;10(10):103. doi:10.1038/s41408-020-00372-5
18. Chari A, Samur MK, Martinez-Lopez J, et al. Clinical features associated with COVID-19 outcome in multiple myeloma: first results from the International Myeloma Society data set. Blood. 2020;136(26):3033-3040. doi:10.1182/blood.2020008150
19. Costa LJ, Chhabra S, Medvedova E, et al. Daratumumab, carfilzomib, lenalidomide, and dexamethasone with minimal residual disease response-adapted therapy in newly diagnosed multiple myeloma. J Clin Oncol. 2022; 40(25):2901-2912. doi:10.1200/JCO.21.01935
20. Voorhees PM, Kaufman JL, Laubach J, et al. Daratumumab, lenalidomide, bortezomib, and dexamethasone for transplant-eligible newly diagnosed multiple myeloma: the GRIFFIN trial. Blood. 2020;136(8):936-945. doi:10.1182/blood.2020005288
21. Mateos MV, Martínez BP, González-Calle V. High-risk multiple myeloma: how to treat at diagnosis and relapse? Hematology Am Soc Hematol Educ Program. 2021;2021(1):30-36. doi:10.1182/hematology.2021000229
22. Terpos E, Engelhardt M, Cook G, et al. Management of patients with multiple myeloma in the era of COVID-19 pandemic: a consensus paper from the European Myeloma Network (EMN). Leukemia. 2020;34(8):2000-2011. doi:10.1038/s41375-020-0876-z
23. Hungria V, Garnica M, Crusoé EQ, et al. Managing patients with multiple myeloma during the COVID-19 pandemic: recommendations from an expert panel - ABHH monoclonal gammopathies committe. Hematol Transfus Cell Ther. 2020;42(3):200-205. doi:10.1016/j.htct.2020.05.001
24. Jethava YS, Fonseca R, Landgren O. Management of multiple myeloma during COVID-19 pandemic. Leuk Res Rep. 2020;14:100212. doi:10.1016/j.lrr.2020.100212
25. Malard F, Mohty M. Management of patients with multiple myeloma during the COVID-19 pandemic. Lancet Haematol. 2020 Jun;7(6):e435-e437. doi:10.1016/S2352-3026(20)30124-1
26. Jimenez-Zepeda VH, Yau P, Stewart D, et al. Impact of COVID-19 on the diagnosis and management of multiple myeloma: experience from a Canadian center. Rev Invest Clin. 2022;74(1):16-22. doi:10.24875/RIC.21000347
27. Neparidze N, Wang R, Zeidan AM, et al. Changes in multiple myeloma treatment patterns during the early COVID-19 pandemic period. Leukemia. 2022;36(8):2136-2139. doi:10.1038/s41375-022-01633-x
28. Richter J, Ailawadhi S, Lee HC, et al. Impact of COVID-19 on treatment patterns and management of multiple myeloma: insights from the Connect® MM Registry. Blood. 2022;140:8089-91. doi:10.1182/blood-2022-158627
29. Shah D, McAuliff K, Pittos E, et al. COVID-19 impact on multiple myeloma prescribing patterns. J Clin Oncol. 2022;40(28_suppl):123. doi:10.1200/JCO.2022.40.28_suppl.123
30. Buske C, Dreyling M, Alvarez-Larrán A, et al. Managing hematological cancer patients during the COVID-19 pandemic: an ESMO-EHA interdisciplinary expert consensus. ESMO Open. 2022;7(2):100403. doi:10.1016/j.esmoop.2022.100403
31. Moreau P. How I treat myeloma with new agents. Blood. 2017;130(13):1507-1513. doi:10.1182/blood-2017-05-743203
32. van de Donk NWCJ, Richardson PG, Malavasi F. CD38 antibodies in multiple myeloma: back to the future. Blood. 2018; 131(1):13-29. doi:10.1182/blood-2017-06-740944
33. Wang Y, Sanchez L, Siegel DS, Wang ML. Elotuzumab for the treatment of multiple myeloma. J Hematol Oncol. 2016;9(1):55. doi:10.1186/s13045-016-0284-z
34. Lonial S, Lee HC, Badros A, et al. Belantamab mafodotin for relapsed or refractory multiple myeloma (DREAMM-2): a two-arm, randomised, open-label, phase 2 study. Lancet Oncol. 2020;21(2):207-221. doi:10.1016/S1470-2045(19)30788-0
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