| Autologous haematopoietic cell transplantation |
Pursue induction regimens of up to six cycles in all patients to postpone the transplant procedure In standard-risk multiple myeloma, consider doing additional cycles of induction, and delaying transplant until first relapse Patients with high-risk cytogenetics (especially those with deletion of chromosome 17p) should still receive high-dose melphalan and AHCT as first-line treatments whenever possible Test patients for SARS-CoV-2 infection before transplant |
| Use of steroids |
Consider reducing steroid doses, as done in older patients, and to possibly interrupt steroids in patients already in complete remission while receiving continuous treatment |
| Management of outpatient visits |
To reduce unnecessary visits to the hospital, consider doing the following:
Use teleconsultation Pharmacists should be able to provide prescription doses for 2–3 months of treatment at a time Favour home hospitalisation or home care Change the treatment administration schedule to one with a lower frequency Change the administration of daratumumab to every 4 weeks instead of every 2 weeks after the initial 8-week weekly administration, in patients with very good partial response Switch from an intravenous or subcutaneous treatment to a fully oral treatment combination For bisphosphonate intravenous home administration, switch from an intravenous to an oral bisphosphonate or transient interruption
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| Clinical trials and clinical research activities |
For patients already enrolled in clinical trials, their participation should, in principle, continue with the following recommendations:
Outpatient visits should be replaced by teleconsultation Clinical research organisations should allow home delivery of the medication under investigation to avoid hospital visits Hospital pharmacies should be authorised to deliver 2–3 months' worth of medication For patients who are likely to benefit substantially from inclusion in a clinical trial, test them for SARS-CoV-2 infection before enrolment For inclusion of new patients in a clinical trial, each team must carefully weigh the advantages and disadvantages of each inclusion
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