Table 1 Summary of currently available recommendations.
IMS [33]a | ASH [27]a | Onkopedia [29] | HOVON/Dutch Federation of Hematology [32] | ||
|---|---|---|---|---|---|
General | |||||
Patient education | √ | √ | √ | √ | √ |
Individualized approach | √ | √ | √ | √ | √ |
Telemedicine | √ | √ | √ | √ | √ |
Oral drugs | Endorsed | Endorsed | Endorsed | Endorsed | NR |
Reschedule iv/sc drugs | √ | √ | √ | √ | No |
Reduced dexamethasone | √ | NR | √ | √ | No |
GCSF when high risk for neutropenia | NR | √ | √ | √ | NR |
Maintenance | Continue | Continue; if high-risk on VRd may change to Rd | Continue | Continue | Continue, reduce visits |
Antiresorptive therapy | NR | Switch every 3 months or postpone | Extend dosing interval or switch to oral clodronate | NR | NR |
MM patient COVID-19 | NR | Interrupt maintenance until infection resolution | NR | Patient isolation; postpone treatment if symptomatic; individualized approach | Suspend all myeloma treatment until full recovery |
NDMM fit | |||||
Induction | Up to 6 cycles; Standard risk: Additional induction cycles/lenalidomide maintenance; High risk: Do not postpone treatment | VRd up to 6-8 cycles | Rd (NHS); VTD or VCD (UK Myeloma forum) for 6 cycles with weekly bortezomib; Immediate treatment only for those with CRAB, delay treatment for those with SLiM or mild anemia | As per current guidelines | As per current guidelines; once started, continue normally with no change of dose/schedule. Start treatment upon hypercalcemia, renal impairment or severe bone lesions. Watchful waiting for anemia only. |
Mobilization/ Stem cell collection | NR | Delay | Proceed; GCSF-only priming regimen | NR | According to guidelines when possible |
HDM/ASCT | Postpone, if possible | Delay | Delay; Consider to proceed only for high-risk patients | Delay | Preferentially according to schedule; if not, add two more induction cycles |
COVID-19 test before ASCT | ✓ | NR | NR | NR | NR |
NDMM unfit | |||||
Regimen | Rd | VRd or DaraRd, if necessary Rd only | Rd for 9 cycles then R maintenance; Immediate treatment only for those with CRAB, delay treatment for those with SLiM or mild anemia | As per current guidelines | Start treatment upon hypercalcemia, renal impairment or severe bone lesions. Watchful waiting for anemia only. As per current guidelines; once started, continue normally with no change of dose/schedule |
Dexamethasone | 20 mg weekly; discontinue if good response | NR | De-escalation after cycle 9 | Reduce | NR |
RRMM | |||||
Regimens | If good response → weekly instead of biweekly regimens, oral agents, monthly infusions of mAbs | Individualized approach | Prefer PomDex if previous Len (NHS); watchful waiting for biochemical relapse; DaraVd instead of second transplant | As per current guidelines; watchful waiting for slow, asymptomatic relapses | Continue treatment when possible or suspend temporarily in responding patients |
Clinical trials | |||||
Consider inclusion; Ongoing patients to continue, reduce visits | Minimize visits; Consider inclusion for those with no other therapeutic choices; Screen for SARS-CoV-2 before administrating an investigational agent; Consider compassionate use programs | NR | NR | Inclusion in trial only when the trial is not on holt and available. | |
