The Myeloma Sessions: Evolving management of myeloma & COVID-19
Aug 6, 2020
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María-Victoria Mateos discusses evolving management of myeloma & COVID-19, including reducing infection risk, mortality rates of myeloma patients, immunity and thrombogenic potential of COVID-19, managing myeloma patients, repurposing myeloma drugs for COVID-19 treatment, and advancements in CAR-T and bi-specific therapies for multiple myeloma.
Myeloma patients infected with COVID-19 in Spain had higher mortality rates, with predictors including age, gender, disease activity, renal impairment, and comorbidities.
Recent conferences showcased promising advancements in myeloma treatment, with targeted therapies like CAR-T cell therapies and bispecific monoclonal antibodies demonstrating impressive efficacy, raising hopes for improved outcomes and prolonged survival.
Deep dives
Evolution of Strategies to Reduce Risk for Myeloma Patients during COVID-19
In Spain, the myeloma group launched recommendations to maintain disease control and minimize patient visits to hospitals, especially for young patients with active disease. Elderly patients with renal impairment were advised to stay at home and receive oral drug combinations. In New York, therapy was selectively used, trials were halted, and patients were managed with optimized infection control. Similar approaches were taken in Greece, where myeloma patients were tested for SARS-CoV-2 virus and treatments were adjusted based on patient characteristics and disease severity. Management strategies included low molecular weight heparin therapy and prioritizing disease control in patients infected with COVID-19.
Insights from Mortality Rates in Myeloma Patients Infected with COVID-19
In Spain, myeloma patients infected with COVID-19 had a higher mortality rate compared to non-cancer patients, with male gender, age over 65, disease activity, renal impairment, and comorbidities as predictors of higher mortality. In New York, mortality rates were high in heavily treated patients, especially those with precursor conditions. However, the use of immunomodulatory drugs or monoclonal antibodies did not impact mortality rates in myeloma patients. Data from an international study showed similar mortality rates for hospitalized myeloma patients. Thrombogenic events were identified as a concern, leading to the use of low molecular weight heparin.
Key Updates and Advances in Myeloma Treatment from Recent Oncology Conferences
Recent conferences showcased promising advancements in myeloma treatment. Targeted therapies like BCMA-targeted CAR-T cell therapies and bispecific monoclonal antibodies demonstrated impressive efficacy, with high response rates and extended duration of response. Combination therapies, such as CAR T-cells with anti-CD38 monoclonal antibodies or CAR FILZOMIB with anti-CD38 antibodies, showed potential for high-risk patients. Researchers also highlighted the importance of disease control and the need to address high-risk disease better. The evolving landscape of cellular therapy and novel oral agents, including cereblon ligase modulators, offered promising options, raising hopes for prolonged survival and improved outcomes.
Considerations for Myeloma Treatment during COVID-19
The COVID-19 pandemic has prompted adapted treatment strategies for myeloma patients. Prioritizing disease control is crucial, and maintaining regular treatments, such as lenalidomide or other standard regimens, can be beneficial. The use of low molecular weight heparin has been recommended for thromboprophylaxis in hospitalized patients. Some myeloma drugs, including immunomodulatory drugs, did not show increased risks for COVID-19 mortality. However, caution is advised with the use of carfilzomib-based therapies due to the underlying risk of endothelial adverse events. The advances in cellular therapy, such as CAR-T cells and bispecific antibodies, offer new hope for improving outcomes and may allow for tailored therapies in the COVID-19 era.
Patients with cancer frequently exhibit poorer post-COVID-19 infection outcomes, therefore the management of patients with hematological malignancies remains of high importance. Several strategies have been employed to reduce the risk of infection, whilst still providing appropriate therapies for high-risk patients.
In this podcast, Paul Richardson, of the Dana-Farber Cancer Institute, Boston, MA, chairs a thoughtful discussion with María-Victoria Mateos of the University Hospital of Salamanca, Salamanca, Spain, Evangelos Terpos of the University of Athens, Athens, Greece, and Ajai Chari of Mount Sinai, New York, NY, on the treatment of multiple myeloma in the face of the COVID-19 pandemic. The speakers discuss evolving strategies to reduce risk of COVID-19 infection in myeloma patients, perspectives from Spain, New York, and Greece, recommendations from the International Myeloma Society (IMS), as well as the key updates following the virtual ASCO and EHA meetings.