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

Publication

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

Journal Paper/Review - May 4, 2023

Terpos Evangelos, Musto Pellegrino, Engelhardt Monika, Delforge Michel, Cook Gordon, Gay Francesca, van de Donk Niels W C J, Ntanasis-Stathopoulos Ioannis, Vangsted Annette Juul, Driessen Christoph, Schjesvold Fredrik, Cerchione Claudio, Zweegman Sonja, Hájek Roman, Moreau Philippe, Einsele Hermann, San-Miguel Jesús F, Boccadoro Mario, Dimopoulos Meletios A, Sonneveld Pieter, Ludwig Heinz

Citation

Terpos E, Musto P, Engelhardt M, Delforge M, Cook G, Gay F, van de Donk N, Ntanasis-Stathopoulos I, Vangsted A, Driessen C, Schjesvold F, Cerchione C, Zweegman S, Hájek R, Moreau P, Einsele H, San-Miguel J, Boccadoro M, Dimopoulos M, Sonneveld P, Ludwig H. Management of patients with multiple myeloma and COVID-19 in the post pandemic era: a consensus paper from the European Myeloma Network (EMN). Leukemia 2023; 37:1175-1185.

Type

Journal Paper/Review (English)

Journal

Leukemia 2023; 37

Publication Date

May 4, 2023

Issn Electronic

1476-5551

Pages

1175-1185

Brief description/objective

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.