Mayo Clinic Experts Release COVID-19 Recommendations
All myeloma patients should be screened for COVID-19 before starting therapy according to recommendations released by Mayo Clinic experts in a paper published on April 17, 2020 in the online journal Acta Hæmatologica.
Screening is essential because “treatment for myeloma can aggravate the adverse events of an active COVID-19 infection,” according to the authors. “Screening should be done for outpatients as well as inpatients initiating therapy.” Should a patient be tested positive for COVID-19, myeloma treatment should be stopped until a full recovery is achieved.
Reflecting the unprecedented uncertainty of this pandemic, the authors emphasized that their “recommendations are based on [their personal] experience and are not evidence based.” There is simply not enough time to conduct broad-based studies given the fast moving nature of COVID-19 infection, but it is still essential to have “strategies…to deliver the best care” possible.
As important as medical treatment is, for patients, caregivers, and family members, it is “critical” that all focus on their own mental health. Should there be indications of overwhelming stress, the authors strongly advised following the advice of the Suicide Prevention Hotline.
High-risk patients “have a greater risk of morbidity than COVID-19 infection” and should continue with active therapy under the direction of their physicians. Those at highest risk have “genetic abnormalities [that] include t(4;14), t(14;16), t(14:20), 17p del, 1q+ and p53 mutations.”
For relapsed patients “daratumumab-based regimens are recommended.”
Standard-risk patients can often be switched successfully to all-oral regimens “to decrease the risk of weekly hospital visits and exposures” for the foreseeable future. Those receiving bortezomib infusions, they “should be given subcutaneously once a week, rather than intravenously or twice weekly.” The authors also outlined various drug treatment combinations and administration schedules as possible options.
There are no additional recommendations for most patients with smoldering myeloma. Only those diagnosed with high-risk smoldering myeloma should consider being treated within a clinical trial.
Additionally, “decreasing the frequency of blood work…as much as possible” should not affect the majority of patients in the short-term.
Reflecting the comments of other specialists around the nation, the authors note that while much clinical trial activity has been temporarily halted, “[s]ome…are modifying their protocols” with the use of local labs, telemedicine, and oral drug home delivery.