Clinical features and treatment strategy for patients with multiple myeloma during the COVID-19 pandemic

Abstract

Background. In March 2020, doctors faced the problem of severe COVID-19 coronavirus infection in patients with multiple myeloma. This required a review of issues related to the selection of patients, the development of new preventive and therapeutic tactics aimed at treating infectious and immunological complications in patients of this category, depending on the nature and status of the underlying disease and the timing of treatment.Aim. To assess the severity of multiple myeloma, the most common complications and features of the COVID-19 course in patients with multiple myeloma at different therapy stages (disease onset, remission, maintenance therapy, progression/refractory disease).Materials and methods. From March 2020 to May 2022, 89 patients diagnosed with multiple myeloma and coronavirus infection caused by the SARS-CoV-2 virus were hospitalized at City Clinical Hospital No. 52 (Moscow). After assessing the severity, a decision was made on patient management, and if necessary, according to indications, the patient received specific antitumor therapy for multiple myeloma and treatment of coronavirus infection simultaneously.Results. Treatment for coronavirus infection was carried out in accordance with the clinical recommendations of the Russian Ministry of Health at that time. It included antiviral, anticoagulant therapy, transfusions of fresh frozen convalescent plasma with a high titer of antibodies, genetically engineered biological drugs and monoclonal antibodies; if necessary, patients received antibacterial and antifungal, hormonal therapy. Specific chemotherapy was also administered according to indications.Conclusion. Patients with multiple myeloma are at higher risk of severe COVID-19 infection. Today, the problem of developing adequate therapeutic tactics for managing patients with multiple myeloma and coronavirus infection still remains relevant. It is necessary to develop an optimal protocol for the management of such patients, including an assessment of prognostic factors, identification of clearly defined indications and contraindications for chemotherapy, and a description of supportive therapy.

Keywords

• multiple myeloma
• covid-19
• viral infections
• chemotherapy
• immunodeficiency