Management of hematological cancer patients in SARS-CoV-2 pandemic: Focus on multiple myeloma patients in a sicilian hospital
Authors: V. Del Fabro, A. Romano, C. Bellofiore, A. Bulla, B. Garibaldi, U. Markovic, F. Di Raimondo, C. Conticello
Journal: HemaSphere (2021)

Background: Rapid diffusion and fatal complications of COVID- 19 has questioned how to manage cancer patients that have a frail immune system and have an increased risk of SarS-CoV-2 case fatality. Methods: Since the beginning of the pandemic, the Division of Hematology at Policlinico, Catania, Italy, has applied different strategies to minimize the risk of infection without lowering the standards of care. Myeloma patients were managed as follows: -for not transplant eligible patients, completely oral regimens were considered more frequently than before with the exception of aggressive disease and disease with renal involvement;-home delivery systems for oral drugs in stable patients were used;-for transplant eligible NDMM patients induction therapy was prolonged to five or six VTD cycle to delay stem cell mobilization and transplantation procedure and reduce risk of neutropenia;- sMM, standard risk relapsed patients with low tumor burden, and slow biochemical relapses were treated as before;- anti-MM treatments were temporary interrupted when COVID-19 positivity was detected;-for RRMM that have obtained a continuous and durable very good response(VGPR) or better to ev drugs, novel approaches in schedule of intravenous drugs were standardized to limit access of patients to the hospital;- for RRMM that have obtained a continuous and durable VGPR or better to oral drugs rest period was lengthened. Indeed, clinical trials continue as before, and MM Unit is participating to a national and an international COVID-19 cancer registry. Results: We have reported 0.24% of infections (12 patients among 4944, 83% symptomatic) and, among positive symptomatic patients, one death (8.3%). Between May 19 and December 25, we have diagnosed 0.85% of infections (56 patients 30% symptomatic), among which 10.7% of death (six patients). Fortunately among health care personnel only 8 cases of infections were diagnosed only in the second wave of COVID-19 pandemic, mostly asymptomatic (75%). Regarding patients affected by plasma cell dyscrasias, a total of 26 patients were recorded corresponding to the 38% of total positive patients following at the Hospital. Among them, 14 MM patients, 8 MGUS patients, 2 patients affected by AL and 2 by WD. Seven patients were hospedalized (5 MM, one MGUS, one AL), two patients died (one AL and one MM). Tele-consultation, usually offered to the patients for short communications, improves of more than three times (4351 e-mails were received 2020, 9522 from 2012 to 2019, 1360 per year);drugs delivery for oral-based regimes allows to treat about 150 patients at home. After informed consent, modified ev drugs regimens were applied to 22 patients out of 70 that have achieved VGPR or better as follows: EloRd was administered every 21 days instead of 15 days after 12 cycles, KRd was administered two times in a cycle instead of four times after 18 cycles, Daratumumab in monotherapy or in combination with lenalidomide and desamethasone or bortezomib and desamethasone from 13 cycle was administered every 35 days instead of 28 days. All patients maintained previous obtained response to therapy. Conclusions: Re-scheduling of ev treatment allows to maintain drugs efficacy without interrupt treatment and by reducing access to the hospital. We therefore encourage strict attention to guidelines to protect the living with prompt hematological malignancy diagnosis and care without lowering the standards of care.