Management of patients with multiple myeloma and COVID-19 in the post pandemic era: a consensus paper from the European Myeloma Network (EMN)
Evangelos Terpos 1 , Pellegrino Musto 2 3 , Monika Engelhardt 4 , Michel Delforge 5 , Gordon Cook 6 , Francesca Gay 7 , Niels W C J van de Donk 8 , Ioannis Ntanasis-Stathopoulos 9 , Annette Juul Vangsted 10 , Christoph Driessen 11 , Fredrik Schjesvold 12 13 , Claudio Cerchione 14 , Sonja Zweegman 8 , Roman Hajek 15 , Philippe Moreau 16 , Hermann Einsele 17 , Jesus San-Miguel 18 , Mario Boccadoro 7 , Meletios A Dimopoulos 9 , Pieter Sonneveld 19 , Heinz Ludwig 20
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.
CITATION Leukemia. 2023 May 4;1-11. doi: 10.1038/s41375-023-01920-1