key: cord-0698100-lv098u91
authors: Buske, Christian; Dreyling, Martin; Alvarez-Larrán, Alberto; Apperley, Jane; Arcaini, Luca; Besson, Caroline; Bullinger, Lars; Corradini, Paolo; Della Porta, Matteo Giovanni; Dimopoulos, Meletios; D’Sa, Shirley; Eich, Hans Th.; Foà, Robin; Ghia, Paolo; Gomes da Silva, Maria; Gribben, John; Hajek, Roman; Harrison, Claire; Heuser, Michael; Kiesewetter, Barbara; Kiladjian, Jean Jacques; Kröger, Nicolaus; Moreau, Philippe; Passweg, Jakob R.; Peyvandi, Flora; Rea, Delphine; Ribera, Josep-Maria; Robak, Tadeusz; San-Miguel, Jesus F.; Santini, Valeria; Sanz, Guillermo; Sonneveld, Pieter; von Lilienfeld-Toal, Marie; Wendtner, Clemens; Pentheroudakis, George; Passamonti, Francesco
title: Managing hematological cancer patients during the COVID-19 pandemic: An ESMO-EHA Interdisciplinary Expert Consensus
date: 2022-01-28
journal: ESMO Open
DOI: 10.1016/j.esmoop.2022.100403
sha: d899f0be71a82c196c3c8c419643d1a7b7de55d1
doc_id: 698100
cord_uid: lv098u91

BACKGROUND: The COVID-19 pandemic has created enormous challenges for the clinical management of patients with hematological malignancies, raising questions about the optimal care of this patient group. METHODS: This consensus manuscript aims at discussing clinical evidence and providing expert advice on statements related to the management of hematological malignancies in the Covid-19 pandemic. For this purpose, an international consortium was established including a steering committee, which prepared six working packages addressing significant clinical questions from the Covid-19 diagnosis, treatment, and mitigation strategies to specific-HM management in the pandemic. During a virtual consensus meeting, including global experts and lead by the European Society for Medical Oncology and the European Hematology Association, statements were discussed and voted upon. When a consensus could not be reached, the panel revised statements to develop consensual clinical guidance. RESULTS AND CONCLUSION: The expert panel agreed on 33 statements, reflecting a consensus, which will guide clinical decision making for patients with hematological neoplasms during the COVID-19 pandemic.

The novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) led to a worldwide pandemic in 2020 and has become a major global health concern affecting over 220 million people and causing over 4.5 million deaths worldwide until September 2021 (https://coronavirus.jhu.edu/map.html). Covid-19 is a systemic disease with most of the patients presenting with mild or moderate symptoms. However, up to 5-10% will present severe or life-threatening disease course and dysfunctions, and complications can persist for at least 6 months after diagnosis. [1] , [2] Because of immunosuppression the potential threat of Covid-19 to cancer patients is significant and a higher mortality rate has been documented for multiple cancers worldwide. [3] Immunosuppression is particularly evident in hematological malignancies (HMs) such as leukemias, myelodysplastic syndromes (MDS), myeloproliferative neoplasms (MPN), lymphomas, and multiple myeloma (MM). This is based on the fact that malignant transformation in HM affects immunocompetent cells themselves and/or that anticancer treatments targeting the transformed immune cells regularly compromise their normal healthy counterparts. Based on large cohorts, [4, 5] international registries [6] and meta-analysis [7] , the mortality of Covid-19 in HM is high with about 35% of patients dying with documented SARS-Cov-2 infection. Mortality was also assessed in distinct HM as MM, [8] chronic lymphocytic leukemia (CLL), [9] non-Hodgkin lymphomas (NHL), [10] and in patients who received hematopoietic stem-cell transplantation (HSCT) [11] , disclosing a fatality rate of 33%, 33%, 34%, and 33%, respectively. In most of these studies, risk factors for worse outcome comprised of advanced age, more severe HM type, progressive disease status, and Covid-19 severity. Of note, treatment-mediated immune dysfunction, caused by e.g. chemoimmunotherapy or BTK inhibition is the main driver of the low rate of seroconversion post Covid-19, estimated at 69% in the whole HM population. [12] .

The dismal outcome of Covid-19 in HM and the emergence of new virus variants with higher infectivity rate [13] emphasizes the need for early introduction of vaccination program in these patients. However, it has been convincingly shown that anti-COVID-19 vaccines elicit an impaired antibody response in patients with HM. [14] [15] [16] [17] Lower rate of seroconversion (40-89%) has been reported in lymphoproliferative disorders due to disease and/or drug-induced B-cell or plasma cell depletion and/or disruption of the B-cell receptor signaling pathway. [18- J o u r n a l P r e -p r o o f 23] Longer time from their exposure can favor immune response in these conditions. [23] . [21, [24] [25] [26] [27] [28] Myeloid neoplasms has been studied less: the rate of post vaccine seroconversion seems higher (85-90%) in MPNs and CML, [26, [29] [30] [31] [32] except in patients receiving JAK inhibitors (near 60%). [30] Based on the known frailty of HM, the rapidly changing situation during the pandemic with its multiple infectious waves and the spread of distinct virus variants worldwide, and the highly divergent situation of the health system in different countries, management of HM patients has focused on avoiding hospital stays and reducing immunocompromising treatments, up to There are several studies indicating efficacy of preventing strategies such as keeping distance, using face masks, and implementing quarantine and isolation in the control of SARS-CoV-2 transmission and thereby disease burden. [33] [34] [35] [36] [37] [38] [39] Reorganization of clinic visits and management of Hematology Units to reduce the risk of transmission have been reported by many to be feasible. [40] [41] [42] Measures may include but are not limited to implementing telehealth, defining dedicated areas and teams for care of HM patients and screening of the staff.

However, this needs to be adapted to local strategies and policies. There is evidence to support J o u r n a l P r e -p r o o f the efficacy of vaccinating household members and care givers derived from studies on vaccination of staff in nursing homes. [43] Final voting: agree 100%, disagree 0% (0/33) Are anti Covid-19 vaccines indicated in HM patients to prevent SARS-CoV-2 infection? STATEMENT 2: Vaccination is strongly recommended. Whenever possible, vaccination should be proposed before initiation of treatment. If this is not possible, vaccines can be administered anytime during disease course or any therapy in principle. In the case an urgent treatment is required, withholding the planned therapy for receiving vaccines is not justified. To note, immune response might be severely reduced in those receiving B-cell depleting agents.

Currently, there are efficient vaccines for immunocompetent individuals, licensed against Covid-19. [44] [45] [46] Generally, vaccines work in patients with HM with immune [47] and clinical responses [48] [49] [50] and are currently generally recommended. [51] [52] [53] By consequence, one can assume that vaccination against SARS-CoV-2 might be effective in HMs, [54] however, these immunocompromised patients have not been included in the registration clinical trials. Reports on anti-SARS-CoV-2 vaccine efficacy in HM disclosed a lower humoral immune response compared that obtained in the heathy population. [14] [15] [16] [17] [18] [19] [20] [21] [22] [23] [24] [25] [26] [27] [28] [29] [30] [31] [32] Special considerations need HM patients receiving B cell depleting therapy, anti-CD38 monoclonal antibodies, and JAK inhibitors for the higher risk of failing seroconversion after SARS-CoV-2 vaccines. [14] [15] [16] [17] [18] [19] [20] [21] [22] [23] [24] [25] [26] [27] [28] [29] [30] [31] [32] Concerning HSCT, many patients will lose their immunity following transplantation, but can generally begin to be vaccinated around three months after the procedure. In consideration of the potential ineffectiveness of immune system, HM patients should be tested for seroconversion after SARS-Cov-2 vaccines and should maintain all the protective measures.

There is no rationale to stop ongoing therapy pre-vaccination since side effects are not influenced by concurrent HM treatment. [55] against SARS-CoV-2. We recommend screening all asymptomatic patients for SARS-CoV-2 at admission for in-hospital stay, 2-3 days later, and then following local policy. Concerning outpatient clinic visits, we encourage developing local policies according to local risk and recommend testing in the case of high SARS-CoV-2 incidence in the community.

As there is clear evidence that patients with asymptomatic Covid-19 may spread the virus in any facility, screening of patients admitted for an in-hospital stay is the first and foremost step to keep care facilities Covid-free areas. [62] Testing at presentation of symptoms should be performed in all HM patients regardless of their current disease status and therapy. Following several reports on prolonged viral shedding especially in patients with severe course of the disease and those with low numbers of B cells, [63] [64] [65] it should be considered to perform follow-up tests until negative results are confirmed before the admission to the Care Units.

Viability of SARS-CoV-2 can only be proven by viral culture, but this is not routinely recommended. Therefore, the interpretation of a positive detection should be carefully examined. Some Institutions perform screening in the outpatient clinic during phases of high incidence in their community. This is a feasible strategy to avoid spread amongst those patients whose treatment cannot be deferred. In the setting of acute leukemias, PCR testing before every chemotherapy cycle is strongly recommended. What type of test should be used with which material? STATEMENT 5: NAT (Nucleic Acid Amplification Technique) testing is preferred, usually using RT-PCR as the most sensitive method. Material from respiratory tract should be used, swabs are preferred but spit-tests, throat gargles, sputum and naso-pharyngeal aspirates are also under investigation. The evaluation of serum neutralizing antibodies for detecting immune response after exposure to SARS-CoV-2 is encouraged, when feasible.

The current gold standard and most widely used assays for the diagnosis of SARS-CoV-2 infection are based on RT-PCR and reported on the web at https://www.360dx.com/coronavirus-test-trackerlaunched-covid-19-tests. Target genes tested include RNA-dependent RNA polymerase (RdRp), open reading frame (ORF1), envelope (E), and nucleocapsid (N) genes of the SARS-CoV-2 genome. Falsenegative results may be due to improper sampling, degradation of the viral RNA during shipping/storage, low viral loads, incorrect nucleic acid extraction, presence of amplification inhibitors, and mutations in the RT-PCR target region. A false positive is mostly due to sample cross contamination. To note, in long lasting positive tests, [66] viability of SARS-CoV-2 can only be proven by viral culture, however, this is not recommended routinely. NAT is preferred over antigen testing to diagnose SARS-CoV-2 infection, because of higher sensitivity. In fact, the sensitivity of antigen tests may drop down to 50% in asymptomatic cases, which does not make them a reliable tool for the diagnosis of infection especially in HMs. [67] [68] [69] [70] [71] [72] Most centres use swabs for detecting SARS-CoV-2 RNA, but alternative clinical samples like saliva or sputum may also provide reliable results and reduce contact between HCPs and infected individuals. However, it seems that the best results can be expected from nasopharyngeal swabs or saliva. [73] [74] [75] [76] [77] The evaluation of serum neutralizing antibodies for detecting immune response after exposure to SARS-CoV-2 is encouraged, and in HM, a lower rate of seroconversion is expected as estimated at 69%. [12] Final voting: agree 90.91%, abstain 9.09%, disagree 0% (0/33)

With the aim to reduce hospital visits and stay during the pandemic, how is it possible to apply imaging techniques to efficiently stage and restage HM patients? STATEMENT 6: A cancer care prioritization and treatment intensity approach has been adapted for HM patients during the pandemic. HM patients, deemed appropriate for treatment because J o u r n a l P r e -p r o o f of their high-risk disease, should be imaged as needed and as closely as possible to pre-pandemic levels. Imaging in HM patients with low-risk disease should be restricted to that level which is necessary to assess their clinical risk status.

For HM in the curative setting, the risk-benefit balance during the SARS-COV-2 pandemic clearly favors maintaining established treatment guidelines and multidisciplinary discussions should recommend standard imaging. In HM patients with low-risk disease, imaging should be restricted to that necessary to assess clinical risk status. To note, imaging resources may be limited during the pandemic for monitoring Covid-19 patients. Finally, a careful scheduling of imaging may avoid unnecessary hospital visits. While hematologists should continue to discuss fertility issue with patients to maximize the likelihood of a successful pregnancy after chemo regimens, the possibility to offer fertility preservation during the pandemic may be compromised by limited facility availability.

Depending on patients' preferences, less intensive regimens (e.g., ABVD instead of eBEACOPP for patients with Hodgkin lymphoma) may be an option when semen or oocyte/ovarian tissue cryopreservation is not feasible. high risk for febrile neutropenia (>20%), and specifically for elderly patients with comorbidities.

Immunoglobulin replacement whose administration should be carefully weighed against the risk of additional hospital visits can be used, favorably by SC application.

Most systemic therapies used in high-risk HM are associated with a significant risk of immunosuppression. Therefore, relevant supportive measures should be implemented such as prophylactic use of hematopoietic growth factors in all regimens with a medium/ high risk of immunosuppression. [78] Moreover, to lower the risk of febrile neutropenia, the indication for G-CSF can be extended. The theoretical concern raised of acute respiratory failure due to G-CSF induced leukocyte recovery in patients with a pulmonary infection due to SARS-COV-2 does not outweigh the benefit, but G-CSF should be applied with caution. [79] The use of erythropoietin, within guidelines indication, can be considered to prevent patient's visits for Initially, two negative PCR tests more than 24h apart were required to confirm cure of SARS-CoV-2 infection. To note, many HM patients have positive PCR tests for prolonged periods without active infection. [66] However, studies on the associations between swab test result, number of cycle thresholds, viral loads, viral cultures and disease status and infectivity did not include significant numbers of severely immunosuppressed patients or patients with HM [82, 83] and therefore this data cannot be considered final. Viral persistence, reactivation, or reinfection with novel variants of SARS CoV2 is a potential risk for the patients resuming therapy, and for other HM patients in the same wards and outpatient clinics. There are a number of reports of prolonged infections in immunosuppressed patients, especially if receiving corticosteroids, intensive treatments and anti CD20 monoclonal antibodies. [84, 85] The decision to rechallenge with anti-cancer therapy should consider the type of treatment being proposed, since there is a suggestion that some targeted therapies are relatively safe even during SARS-Cov-2 infection (20-23), whereas immunochemotherapy poses bigger risks. Risk of immunosuppression related to maintenance has to be considered and discussed with the individual patient. Decision to start or continue maintenance treatment with anti-CD20 may be considered according to the local epidemiological situation and vaccination status.

In the relapsed/refractory setting, if feasible, outpatient management with oral drugs should be considered with limited access to the hospital and drugs including lenalidomide in FL patients should be considered.

In CLL, targeted oral therapies, especially BTK inhibitors or venetoclax should be a preferred option over immunochemotherapy, if available, in both first line and refractory/relapse (R/R) setting, according to the approval of each drug. The use of anti-CD20 antibodies in association with novel inhibitors should be carefully evaluated and postponed if possible. In aggressive lymphoma, when feasible, it is better to delay the start of treatment without compromising treatment in a curative setting. Depending on the Covid-19 circumstances in the community, watchful waiting may be considered for biochemical relapses, especially for patients with a slow and gradual increase in the paraprotein level. However, patients with refractory disease, new onset of CRAB features, or those with a biochemical relapse and a history of aggressive relapse with rapid deterioration of the clinical presentation should receive next-line treatment without delay. [90] Regarding the selection of treatment regimen, orally administered agents (ixazomib, lenalidomide, pomalidomide, panobinostat) should be considered based on logistics. Ph+ALL a chemo-free approach should be considered.

In ALL modifications of the treatment plan are likely to be associated with poorer outcomes.

Adults with additional risk factors for fatal Covid-19 (i.e. diabetes, asthma or chronic obstructive pulmonary disorders, and obesity) should be closely followed. Steroids are considered safe for Covid-19 management and crucial for ALL, hence, they should be used without dose modification in all instances. In Ph-negative ALL the general recommendation is to deliver ALL therapy without modifications. For adult patients with Ph-positive ALL, especially if a high Covid-19 incidence and hospital occupancy are present, a tyrosine-kinase inhibitor (TKI) with steroids is favored over an intensive multi-drug induction chemotherapy for initial treatment. In sharp contrast, intensive multidrug induction chemotherapy is recommended for children and AYA ALL patients. Aggressive post-remission therapy should be administered as scheduled but the use of rituximab for consolidation is controversial due to the frequent need of hospital visits that could put patients at risk. Patients with relapsed or resistant ALL should be treated on a case-by-case basis and considering the availability of clinical trials. In CML, the decision to interrupt TKI treatment in case of admission due to COVID-19 needs to be made on a case-to-case basis considering time on TKI, response to TKI, type of TKI, and risk of CML relapse. To note, TKIs are not considered immunosuppressive, and it is expected that almost all patients still respond after a TKI discontinuation. In patients with concomitant TKIrelated organ damage such as cardiovascular or pulmonary toxicity, the TKI should be stopped J o u r n a l P r e -p r o o f until both Covid-19 and adverse events are resolved. For MPN patients with Covid-19, ruxolitinib discontinuation could be harmful. [112] Final voting: agree 90.91%, abstain 9.09%, disagree 0% (0/33) Is there any indication to change the current approach to SARS-CoV-2 negative CML patients during the Covid-19 pandemic? STATEMENT 31: The general approach to CML patients does not require major modifications in the pandemic, while monitoring and supportive care need careful planning to guarantee safe outpatient treatment of CML patients. Home delivery and telemedicine should be encouraged.

Treatment in newly diagnosed CML should not be postponed as remission induction is considered beneficial, even in the pandemic. However, caution is advised during the first 3 months of TKI treatment as severe cytopenia may occur, thus possibly increasing the severity of Covid 19. The pandemic should not affect the choice of TKI. A recent study found an increased mortality risk in CML patients with Covid-19 when treated with imatinib, but this may be confounded by older age, access to and quality of health services. [113] Patients already in treatment with TKIs should continue their treatment. In case of pulmonary side effects of TKIs, SARS-CoV-2 infection should be ruled out, and side effects aggressively managed. A switch to another TKI may be considered. In patients with long-lasting MR4 or better, TKI may be stopped according to current guidelines and patients may be molecularly monitored monthly for the first 6 months. During the pandemic, monitoring frequency and in person visits should not be modified. In patients progressing to blast crisis the indication for treatment should not be modified or postponed. Finally, in woman with CML who plan to become pregnant and in pregnant women with CML interferon treatment does not require adaptation due to the Covid-19 pandemic. SARS-CoV-2 negative patients with MPN/CML can receive HSCT as indicated. In the case of SARS-CoV-2 positive patients with high risk MPN/CML, HSCT should be deferred until the patient is asymptomatic and has two negative PCR swabs taken at least 24 hours apart. In patients with low-risk disease, who were asymptomatic or only mildly symptomatic with upper respiratory tract symptoms, a deferral of at least 14 days after first negative PCR is indicated with a new PCR test recommended before conditioning; for those with moderate to severe Covid-19, it is recommended to defer HSCT for at least three months. This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors. What are efficient strategies to prevent SARS-CoV-2 infection? 

Hajek has had a consultant or advisory relationship with Janssen, Amgen, Celgene, AbbVie, BMS, Novartis, PharmaMar, and Takeda; has received honoraria from Janssen, Amgen, Celgene, BMS, PharmaMar, and Takeda; has received research funding from Janssen, Amgen, Celgene, BMS, Novartis, and Takeda. 18. Claire Harrison reports grants and personal fees from Novartis, grants and personal fees from BMS, personal fees from Sierra Oncology, personal fees from CTI pharmaceuticals, personal fees from Jannsen, personal fees from Geron, grants and personal fees from AOP, personal fees from Galecto, grants, personal fees and other from Constellation, outside the submitted work; 19. Michael Heuser reports personal fees from Novartis, personal fees from Pfizer, personal fees from Roche, personal fees from Abbvie, personal fees from Daiichi Sankyo, personal fees from Bayer Pharma AG, personal fees from Jazz Pharmaceuticals, personal fees from BMS, personal fees from Tolremo, outside the submitted work; 20. Barbara Kiesewetter has received honoria for lectures from Ipsen, Novartis and MSD (all outside of the submitted work) 21. Jean-Jacques Kiladjian reports consulting fees and honoraria from Novartis, consulting fees from Abbvie, honoraria from AOP Orphan, participation on a monitoring board or advisory board from BS/Celgene, participation on a monitoring board or advisory board from Incyte. 22. Nicolaus Kröger reports grants and honoraria from Neovii, honoraria from Sanofi, grants and honoraria from JAZZ, grants and honoraria from Celgene, grants and honoraria from Riemser, honoraria from Gilead/Kite, honorarium from AOP Pharma, grants and honorarium from Novartis, honorarium from Amgen. 23. Philippe Moreau reports personal fees from Celgene, Amgen, Janssen, Abbvie, Sanofi, outside the submitted work; 24. Jakob Passweg has nothing to disclose. 25 

MorphoSys, Novartis; he reports speaker's engagement: Roche, Janssen, BeiGene, Celltrion, AbbVie, Pfizer, Gilead Sciences; he reports research funding: Roche/Genentech

Alberto Alvarez-Larran has nothing to disclose

Jane Apperley reports personal financial interests as advisory board and invited speaker from Incyte, advisory board from Mallinckrodt, advisory board and invited speaker from Novartis, advisory board and invited speaker from Pfizer; she reports non-financial interests as principal investigator from Incyte

Luca Arcaini received advisory honoraria from

Caroline Besson has nothing to disclose

Seattle Genetics and has research support from Bayer and Jazz Pharmaceuticals

Paolo Corradini has nothing to disclose

Matteo Giovanni Della Porta has nothing to disclose

Meletios Dimopoulos reports personal fees from AMGEN, personal fees from TAKEDA, personal fees from JANSSEN, personal fees from BEIGENE, personal fees from BMS, outside the submitted work

Sa reports personal financial interests as advisory board, invited speaker, fellow funding, and coordinating PI from Bei Gene, writing engagement from Karger, advisory board and coordinating PI from Sanofi, funding, and other from Janssen; she reports non-financial interests as advisory role at British Society for Haematology Lymphoma Special Interest Group, advisory role at Lymphoma Action

Hans Theodor Eich has nothing to disclose

Robin Foa reports honoraria for advisory boards and/or speaker bureau from Janssen

Paolo Ghia reports grants and personal fees from AbbVie, grants and personal fees from Acerta/AstraZeneca, personal fees from BeiGene

personal fees from MEI, personal fees from Roche, personal fees from Sanofi, personal fees from ArQule/MSD, outside the submitted work

Silva reports grants, personal fees, non-financial support and other from Gilead Sciences, grants from Astrazeneca, personal fees, non-financial support and other from Janssen Cilag, personal fees and non-financial support from Roche, non-financial support from Abbvie, personal fees and non-financial support from Bristol Myers Squibb, personal fees and non-financial support from Merk Sharp and Dhome, personal fees and non-financial support from Takeda, personal fees from Novartis

John Gribben reports personal fees from Abbvie, grants and personal fees from AZ, grants and personal fees from BMS/Celgene, grants and personal fees from Janssen, personal fees from Kite/Gilead, personal fees from Morphosys, personal fees from Novartis

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International Myeloma Working Group updated criteria for the diagnosis of multiple myeloma

Management of patients with multiple myeloma in the era of COVID-19 pandemic: a consensus paper from the European Myeloma Network (EMN)

European Myeloma Network guidelines for the management of multiple myeloma-related complications

International Myeloma Working Group recommendations for the treatment of multiple myeloma-related bone disease

The role of cement augmentation with percutaneous vertebroplasty and balloon kyphoplasty for the treatment of vertebral compression fractures in multiple myeloma: a consensus statement from the International Myeloma Working Group (IMWG)

Treatment of multiple myeloma-related bone disease: recommendations from the Bone Working Group of the International Myeloma Working Group

Risk stratification of smoldering multiple myeloma incorporating revised IMWG diagnostic criteria

Prolonged SARS-CoV-2 viral shedding in patients with solid tumours and associated factors

Case Study: Prolonged Infectious SARS-CoV-2 Shedding from an Asymptomatic Immunocompromised Individual with Cancer

Multiple myeloma and SARS-CoV-2 infection: clinical characteristics and prognostic factors of inpatient mortality

Dexamethasone in Hospitalized Patients with Covid-19

Multiple myeloma: 2020 update on diagnosis, risk-stratification and management

Bortezomib, lenalidomide, and dexamethasone as induction therapy prior to autologous transplant in multiple myeloma

Bortezomib, and Dexamethasone with Transplantation for Myeloma

Multiple myeloma: EHA-ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up(dagger)

Multiple myeloma: Role of autologous transplantation

Bortezomib, thalidomide, and dexamethasone with or without daratumumab before and after autologous stem-cell transplantation for newly diagnosed multiple myeloma (CASSIOPEIA): a randomised, open-label, phase 3 study

Daratumumab, bortezomib, cyclophosphamide and dexamethasone in newly diagnosed and relapsed multiple myeloma: LYRA study

Expert panel consensus statement on the optimal use of pomalidomide in relapsed and refractory multiple myeloma

Isatuximab plus pomalidomide and low-dose dexamethasone versus pomalidomide and low-dose dexamethasone in patients with relapsed and refractory multiple myeloma (ICARIA-MM): a randomised, multicentre, open-label, phase 3 study

Elotuzumab plus Pomalidomide and Dexamethasone for Multiple Myeloma

Oral Selinexor-Dexamethasone for Triple-Class Refractory Multiple Myeloma

Belantamab mafodotin for relapsed or refractory multiple myeloma (DREAMM-2): a two-arm, randomised, open-label, phase 2 study

High mortality rate in COVID-19 patients with myeloproliferative neoplasms after abrupt withdrawal of ruxolitinib

COVID-19 infection in chronic myeloid leukaemia after one year of the pandemic in Italy. A Campus CML report