Table 1.

Summary of currently available recommendations.

	IMS [33]a	ASH [27]a	UK Myeloma Forum [30]/NHS [31]	Onkopedia [29]	HOVON/Dutch Federation of Hematology [32]
General
Patient education	√	√	√	√	√
Individualized approach	√	√	√	√	√
Telemedicine	√	√	√	√	√
Oral drugs	Endorsed	Endorsed	Endorsed	Endorsed	NR
Reschedule iv/sc drugs	√	√	√	√	No
Reduced dexamethasone	√	NR	√	√	No
GCSF when high risk for neutropenia	NR	√	√	√	NR
Maintenance	Continue	Continue; if high-risk on VRd may change to Rd	Continue	Continue	Continue, reduce visits
Antiresorptive therapy	NR	Switch every 3 months or postpone	Extend dosing interval or switch to oral clodronate	NR	NR
MM patient COVID-19	NR	Interrupt maintenance until infection resolution	NR	Patient isolation; postpone treatment if symptomatic; individualized approach	Suspend all myeloma treatment until full recovery
NDMM fit
Induction	Up to 6 cycles; Standard risk: Additional induction cycles/lenalidomide maintenance; High risk: Do not postpone treatment	VRd up to 6-8 cycles	Rd (NHS); VTD or VCD (UK Myeloma forum) for 6 cycles with weekly bortezomib; Immediate treatment only for those with CRAB, delay treatment for those with SLiM or mild anemia	As per current guidelines	As per current guidelines; once started, continue normally with no change of dose/schedule. Start treatment upon hypercalcemia, renal impairment or severe bone lesions. Watchful waiting for anemia only.
Mobilization/ Stem cell collection	NR	Delay	Proceed; GCSF-only priming regimen	NR	According to guidelines when possible
HDM/ASCT	Postpone, if possible	Delay	Delay; Consider to proceed only for high-risk patients	Delay	Preferentially according to schedule; if not, add two more induction cycles
COVID-19 test before ASCT	✓	NR	NR	NR	NR
NDMM unfit
Regimen	Rd	VRd or DaraRd, if necessary Rd only	Rd for 9 cycles then R maintenance; Immediate treatment only for those with CRAB, delay treatment for those with SLiM or mild anemia	As per current guidelines	Start treatment upon hypercalcemia, renal impairment or severe bone lesions. Watchful waiting for anemia only. As per current guidelines; once started, continue normally with no change of dose/schedule
Dexamethasone	20 mg weekly; discontinue if good response	NR	De-escalation after cycle 9	Reduce	NR
RRMM
Regimens	If good response → weekly instead of biweekly regimens, oral agents, monthly infusions of mAbs	Individualized approach	Prefer PomDex if previous Len (NHS); watchful waiting for biochemical relapse; DaraVd instead of second transplant	As per current guidelines; watchful waiting for slow, asymptomatic relapses	Continue treatment when possible or suspend temporarily in responding patients
Clinical trials
	Consider inclusion; Ongoing patients to continue, reduce visits	Minimize visits; Consider inclusion for those with no other therapeutic choices; Screen for SARS-CoV-2 before administrating an investigational agent; Consider compassionate use programs	NR	NR	Inclusion in trial only when the trial is not on holt and available.

NR not reported, IMS International Myeloma Society, ASH American Society of Hematology, NHS National Health Service UK, GCSF granulocyte-colony stimulating factor, (V)Rd (bortezomib)lenalidomide-dexamethasone, (ND/RR)MM (newly diagnosed/relapsed refractory) multiple myeloma, HDM/ASCT high-dose melphalan/autologous stem cell transplant, VTD bortezomib-thalidomide-dexamethasone, VCD bortezomib-cyclophosphamide-dexamethasone, DaraRd daratumumab-lenalidomide-dexamethasone, mAb monoclonal antibody, PomDex pomalidomide-dexamethasone, DaraVd daratumumab-bortezomib-dexamethasone.

^aESMO stratifies patients based on the priority for treatment (high, medium, low) according to the recommendations by IMS and ASH [28].