Leukemiawww.nature.com/leuREVIEW ARTICLE周Check for updatesMULTIPLE MYELOMA,GAMMOPATHIESManagement of patients with multiple myeloma and COVID-19in the post pandemic era:a consensus paper from theEuropean Myeloma Network(EMN)Evangelos Terpos,Pellegrino Musto2,Monika Engelhardt,Michel Delforges,Gordon Cook Francesca Gay,Niels W.C.J.van de Donk,loannis Ntanasis-Stathopoulos,Annette Juul Vangsted,Christoph Driessen0Fredrik Schjesvold112,Claudio Cerchione3,Sonja Zweegman,Roman Hajek4,Philippe Moreau5,Hermann Einsele,Jesus San-Miguel,Mario Boccadoro Meletios A.Dimopoulos Pieter Sonneveldand Heinz LudwigThe Author(s),under exclusive licence to Springer Nature Limited 2023In the post-pandemic COVID-19 period,human activities have returned to normal and COVID-19 cases are usually mild.However,patients with multiple myeloma(MM)present an increased risk for breakthrough infections and severe COVID-19 outcomes,including hospitalization and death.The European Myeloma Network has provided an expert consensus to guide patientmanagement in this era.Vaccination with variant-specific booster vaccines,such as the bivalent vaccine for the ancestral Wuhanstrain and the Omicron BA4/5 strains,is essential as novel strains emerge and become dominant in the community.Boostersshould be administered every 6-12 months after the last vaccine shot or documented COVID-19 infection(hybrid immunity).Booster shots seem to overcome the negative effect of anti-CD38 monoclonal antibodies on humoral responses;however,anti-BCMA treatment remains an adverse predictive factor for humoral immune response.Evaluation of the immune response aftervaccination may identify a particularly vulnerable subset of patients who may need additional boosters,prophylactic therapies andprevention measures.Pre-exposure prophylaxis with tixagevimab/cilgavimab is not effective against the new dominant variantsand thus is no longer recommended.Oral antivirals (nirmatrelvir/ritonavir and molnupiravir)and remdesivir are effective againstOmicron subvariants BA.2.12.1,BA4,BA.5,BQ.1.1 and/or XBB.1.5 and should be administered in MM patients at the time of apositive COVID-19 test or within 5 days post symptoms onset.Convalescent plasma seems to have low value in the post-pandemicera.Prevention measures during SARS-CoV-2 outbreaks,including mask wearing and avoiding crowded places,seem prudent tocontinue for MM patients.Leukemia(2023)37:1175-1185;https/doi.org/10.1038/s41375-023-01920-1INTRODUCTIONdefective immunoglobulin,together with decreased levels ofMultiple myeloma (MM)is a plasma cell neoplasm defined by thenormal immunoglobulin classes and defective cellular and innateaberrant proliferation of clonal plasma cells.Infections are aimmunity,leads to an inadequate host immune response tosignificant cause of morbidity and death in patients with MM [1].pathogens [2].Patient-related factors including age,frailty andThe overload of the monoclonal component comprised ofcomorbidities may increase the susceptibility t
