Approaches to the Management of Older Patients With Multiple Myeloma During the COVID-19 Crisis

Recommendations from the International Forum for Optimizing Care in Older Adults with Multiple Myeloma regarding the management of these patients during the COVID-19 crisis have been summarized in the Journal of Geriatric Oncology.¹

Although data are scarce with respect to the prevalence and clinical sequelae of COVID-19 infection in patients with multiple myeloma, the typically older age and frequent comorbidities of these patients are known risk factors for poor clinical outcomes following infection with COVID-19.

While emphasizing overarching needs for decreased physical contact between the health care system and older patients with multiple myeloma, as well as the importance of individualizing treatment decisions, some of the key elements of these recommendations included consideration of the following:

• Delaying therapy initiation in those individuals with newly diagnosed or relapsed disease at low risk of rapid disease progression and multiple myeloma-associated morbidity, along with close follow-up
• Delaying or omitting upfront autologous stem cell transplantation (ASCT) and, for those proceeding with ASCT, undertaking COVID-19 testing both prior to stem cell harvesting and the ASCT procedure
• When appropriate, selectively treating with triplet therapy regimens in those cases with uncontrolled disease, and providing the support needed to help ensure that these patients are closely followed and managed
• Continuing regimens that are well tolerated in patients with controlled/stable disease considered at low risk of COVID-19 infection
• Considering use of alternative drug schedules and oral regimens, as well as reduced steroid dosing and close monitoring for neutropenia, in patients with controlled/stable disease considered at high risk of developing COVID-19 infection
• Minimizing use of treatments associated with need for red blood cell or platelet transfusions
• Balancing need for supportive care with goal of minimizing patient contact with health care system — for example, delaying administration of bisphosphonates in patients with stable disease in the absence of bone-related disease
• Advocating for patients enrolled in clinical trials to ensure they have access to bridging therapy if clinical trials are disrupted during the COVID-19 pandemic
• Tapering steroids to lower dose and consideration of withholding all anti-myeloma therapy for those with mild symptoms of COVID-19 infection
• Tapering steroids to lower dose, withholding all anti-myeloma therapy, and consideration of enrollment in clinical trial evaluating anti–COVID-19 therapy, for those with severe symptoms of COVID-19 infection
• Communicating with patients regarding treatment decision making and end-of-life preferences, and documenting the outcomes of these discussions.

The members of the International Forum for Optimizing Care in Older Adults with Multiple Myeloma also encouraged participation in patient registries that have been recently established to further understanding of the epidemiology and outcomes of subgroups of patients with cancer infected with COVID-19.^2,3

References

1. Mian H, Grant SJ, Engelhardt M, et al. Caring for older adults with multiple myeloma during the COVID-19 pandemic: Perspective from the International Forum for Optimizing Care of Older Adults With Myeloma. J Geriatr Oncol [published online April 17, 2020]. doi: 10.1016/j.jgo.2020.04.008
2. American Society of Hematology Research Collaborative COVID-19 Registry for Hematologic Malignancy. https://www.ashresearchcollaborative.org/covid-19-registry/. Accessed May 5, 2020.
3. The COVID-19 & Cancer Consortium. https://ccc19.org/. Accessed May 4, 2020.

This article originally appeared on Cancer Therapy Advisor