Radiotherapy in COVID-19 patient affected by multiple myeloma: a case report

Abstract

In COVID-19 pandemic, cancer patients may be vulnerable for their immunological status and need of immunosuppressive anti-neoplastic treatments. Choosing the best treatment option in COVID-19 positive cancer patients is still a challenging issue. We report the case of a 62-year-old woman diagnosed with multiple myeloma and affected by COVID-19. After the diagnosis of multiple myeloma in January 2019, the patient underwent first line therapy followed by bone marrow autologous stem cell transplantation, achieving a complete response in September 2019. In March 2020, the patient showed intrathoracic progression of the disease, resulting in a severe dysphagia and concomitant positivity to SARS-CoV-2 swab test, cough, fever, and dyspnea related to the involvement of the lung parenchyma as shown by CT-scan. After her admittance to a COVID-19 dedicated inward, she was administered oral hydroxychloroquine and darunavir-cobicistat for 7 days with stabilization of her general clinical conditions. For the worsening of dysphagia, after multidisciplinary discussion, it was decided to deliver radiotherapy to the mediastinal and paravertebral mass with 8 Gy single fraction. After 5 days, her clinical conditions improved, with reduction of dysphagia. The CT confirmed a partial response with reduction of the mass of about 50%. Viral clearance was confirmed by triple negative search for SARS-CoV-2 on nasopharyngeal swabs, one month after first documentation of positivity. Unfortunately, the patient died three months later due to a pulmonary mycotic infection causing respiratory failure. To our knowledge, this case report describes the first experience of mediastinal radiotherapy in a COVID-19 patient affected by myeloma reported in the literature. In case of clinical indication, even in presence of SARS-CoV-2 infection, radiotherapy can be safely delivered and might be considered a treatment option as shown by our experience in this challenging case of intrathoracic myeloma.

Comorbidities and mortality rate in COVID‐19 patients with hematological malignancies: A systematic review and meta‐analysis

“…For example, Krengli et al 24 reported that radiation therapy could be considered a treatment strategy in COVID‐19 patients affected by myeloma. Recently, Liu et al 25 demonstrated that patients with hematological malignancies were at a higher risk of death if they received chemotherapy 3 months before the COVID‐19 diagnosis.…”

“…In this regard, it has been demonstrated that radiation therapy has no higher risk of severe events related to the COVID-19 for these patients. 5 For example, Krengli et al 24 with hematological malignancies were at a higher risk of death if they received chemotherapy 3 months before the COVID-19 diagnosis.…”

Characteristics and Outcomes of Stem Cell Transplant Patients during the COVID-19 Era: A Systematic Review and Meta-Analysis

“…This left 57 full-text articles to be assessed for eligibility. Thirty-six of these studies met our eligibility criteria [ 16 , 21 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 , 53 , 54 , 55 , 56 , 57 , 58 , 59 , 60 ]. These studies included a total of 2011 patients, 516 of whom underwent SCT.…”

“… Pooled event rate for COVID-19–related mortality [ 16 , 21 , 27 , 28 , 29 , 30 , 31 , 32 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 45 , 46 , 47 , 48 , 50 , 52 , 53 , 54 , 56 , 58 , 60 ]. …”

“… Pooled event rate for the use of hydroxychloroquine [ 16 , 28 , 29 , 31 , 37 , 38 , 40 , 41 , 42 , 45 , 52 , 56 , 57 ]. …”