Management of patients with multiple myeloma and COVID-19 in the post pandemic era: a consensus paper from the European Myeloma Network (EMN)

Abstract

In the post-pandemic COVID-19 period, human activities have returned to normal and COVID-19 cases are usually mild. However, patients with multiple myeloma (MM) present an increased risk for breakthrough infections and severe COVID-19 outcomes, including hospitalization and death. The European Myeloma Network has provided an expert consensus to guide patient management in this era. Vaccination with variant-specific booster vaccines, such as the bivalent vaccine for the ancestral Wuhan strain and the Omicron BA.4/5 strains, is essential as novel strains emerge and become dominant in the community. Boosters should be administered every 6–12 months after the last vaccine shot or documented COVID-19 infection (hybrid immunity). Booster shots seem to overcome the negative effect of anti-CD38 monoclonal antibodies on humoral responses; however, anti-BCMA treatment remains an adverse predictive factor for humoral immune response. Evaluation of the immune response after vaccination may identify a particularly vulnerable subset of patients who may need additional boosters, prophylactic therapies and prevention measures. Pre-exposure prophylaxis with tixagevimab/cilgavimab is not effective against the new dominant variants and thus is no longer recommended. Oral antivirals (nirmatrelvir/ritonavir and molnupiravir) and remdesivir are effective against Omicron subvariants BA.2.12.1, BA.4, BA.5, BQ.1.1 and/or XBB.1.5 and should be administered in MM patients at the time of a positive COVID-19 test or within 5 days post symptoms onset. Convalescent plasma seems to have low value in the post-pandemic era. Prevention measures during SARS-CoV-2 outbreaks, including mask wearing and avoiding crowded places, seem prudent to continue for MM patients.

Survival in multiple myeloma and SARS‐COV‐2 infection through the COVID‐19 pandemic: Results from the EPICOVIDEHA registry

“…It is, therefore, still mandatory to maintain attention on these individuals 53 . In this setting, the European Myeloma Network has recently provided an updated expert consensus to guide MM patient management also in this “post‐pandemic” era 54 …”

“…It is, therefore, still mandatory to maintain attention on these individuals 53. In this setting, the European Myeloma Network has recently provided an updated expert consensus to guide MM patient management also in this "post-pandemic" era 54. AUTHOR CONTRIBUTIONSPellegrinoMusto, Jon Salmanton-García, Nicola Sgherza, Francesco Marchesi, Oliver A. Cornely and Livio Pagano contributed to study design, study supervision, statistical plan, data interpretation and wrote the paper.…”

Outcomes of COVID‐19 in multiple myeloma patients treated with daratumumab

“…Another reason could be the difference in strains of SARS‐CoV‐2. Patients in our cohort were infected with the Omicron strain, which was reported to have a lower mortality rate than other pandemic strains between 2020 and 2021 27,28 . In addition, differences in race might also play a role.…”

“…Patients in our cohort were infected with the Omicron strain, which was reported to have a lower mortality rate than other pandemic strains between 2020 and 2021. 27 , 28 In addition, differences in race might also play a role. Data from the United States suggested that some racial groups (e.g., Black/African American people, Hispanic people, and American Indian/Alaska Native people) experience higher rates of COVID‐19 infection, hospitalization, and death than the White population.…”

Daratumumab Treatment for “Truly Frail” Elderly Myeloma Patients

“…Several studies on antibody levels following vaccination in MM patients have reported factors contributing to lower positive rates and decreased antibody levels of IgG (immunoglobulin) antibodies, such as advanced age, uncontrolled disease status, multiple comorbidities, low levels of normal immunoglobulins, and lymphocyte reduction [ 134 , 135 ]. Additionally, patients undergoing DARA-containing regimens have been shown to have significantly lower antibody levels when compared to untreated or observed patients [ 134 , 135 , 136 , 137 ]. Particularly for frail patients during the COVID-19 pandemic, it is wise to take preventive measures such as wearing masks, social distancing, avoiding crowded places, and recommending vaccination [ 133 ].…”