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Navigating Lymphoma Care During COVID-19

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Published on April 6, 2020

Key Takeaways

Cancer patients in general are more likely to be at high risk of severe illness from coronavirus. With more than 70 types of lymphoma, how can patients better understand the risks for their specific condition? During this Ask the Expert program, Dr. Joshua Brody, from Mount Sinai School of Medicine, describes the nuances of managing lymphoma during the outbreak.

Watch as Dr. Brody discusses treatment, routine testing and disease monitoring for various types of lymphoma and stages of care. Dr. Brody also shares the age-related and treatment-related risks, and the recommended precautions to prevent COVID-19 exposure. 

As information continues to emerge, Patient Power is taking your questions. Send them in to comments@patientpower.info to be answered on future programs. 

[Due to extreme load on our website and Zoom platform, viewers may experience a time delay between the audio and video of the interview - please note the transcript can be read below.]

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Transcript | Navigating Lymphoma Care During COVID-19

Please remember the opinions expressed on Patient Power are not necessarily the views of our sponsors, contributors, partners or Patient Power. Our discussions are not a substitute for seeking medical advice or care from your own doctor. That’s how you’ll get care that’s most appropriate for you.

Recorded on April 1, 2020

Esther Schorr:
Hi there, and welcome. This is Esther Schorr. It’s April 1st, 2020. And I’d like to welcome all of you to one in a series of our programs on the coronavirus and how it impacts those of us who are either cancer patients, or we are people who love cancer patients and care for them. We’re really honored today to have with us a very special person who deals primarily with patients with various forms of lymphoma, Dr. Joshua Brody. Welcome, Dr. Brody. Dr Brody is the Director of the Lymphoma Immunotherapy Program at Mount Sinai School of Medicine. And you’re right, Dr. Brody, that is a mouthful.
 
Dr. Brody, as you all probably figured out, he is in New York City, which is really kind of a ground zero right now in what the medical community and all of us are dealing with related to the coronavirus. And so what we're going to try to focus on today is talking about the impact of this on patients who are dealing with lymphomas. Now there are all kinds of lymphomas. So at first we'll talk a little bit about in general, are there some things that lymphoma patients in general need to think about? And then we'll talk more specifically if there are some specific issues to whether it's a type of a non-Hodgkin lymphoma or a Hodgkin lymphoma, and are there any differences in things you should be aware of? So, Dr. Brody, we're so glad to have you here.

Dr. Brody:
Esther, thank you, and to you, and to Andrew, and all the folks at Patient Power. We're appreciative of the opportunity to get some good information out there, because that's critical. That's the thing in the modern age, tons of information, so always some good information and always some misinformation. And we like to clarify things, because it's a very scary time for our patients and for everyone, and information can be very calming. So let's do it.

Esther Schorr:
Great. So let's dig in. So I think first, can you kind of give an overview of things that lymphoma patients in general should be discussing with their medical teams in light of what's going on with the coronavirus?

Dr. Brody:
Sure, absolutely. As many discussions we have in the lymphoma space, this has to be incredibly individualized, because patients are so different, not just because people are different, but also because we have more than 70 types of lymphoma. And the discussion would be absolutely different with one type of aggressive lymphoma, Burkitt's lymphoma that we have to treat today, versus follicular lymphoma where a person has been mostly healthy for 15 years since they were diagnosed, and our approach, especially in the context of coronavirus and how we're doing things a little differently, is completely different. So the conversations have to be individualized. It's hard to just go on the Internet and say, "What should a lymphoma patient do?" So how do we individualize? Well, you and I will talk about some individual examples, but also it's talking to your doctor, and how do you do that in a scary time?
 
A lot of it now is becoming telemedicine. We are doing video phone calls with the good majority of our patients. Some patients we still need to come into a clinic and to the hospital. but most patients we're seeing them by video visits, which is not perfect. Sometimes you can't press the right button, and you can't find how to reboot the operating system. But mostly it works okay. It's not ideal medicine, because we do need to examine people, but in some instances it's a lot better than nothing. And we're happy to do it, and our system is kind of set up, so we're able to do that now.

Esther Schorr:
Great. And we can talk a little bit more about when that's appropriate and when not, but maybe let's go back up to the 10,000 foot level. A lot of what we're all hearing is people with cancer are at higher risk. So does higher risk mean a higher risk of getting the illness, the virus, or does it mean if you get it that it will be more severe? Or is it both, and here's the multi-part question, are there differences between the risk you have in one kind of lymphoma versus another or the recency of your treatment?

Dr. Brody:
Sure, absolutely. So a few questions in there. Let's unravel them. The first question is do some of these patients have a higher risk of getting coronavirus infection or a manifestation of it, meaning the syndrome? There's a lot of people, in fact, maybe a majority that get infected with the virus and never feel anything. And I know a bunch of people, colleagues and friends who tested positive, never had a fever, never had a cough, never even had a sore throat. But they tested because maybe they were exposed to someone, a friend or something. So there's getting the virus, and then there's getting the infectious syndrome, the cough, the fever, the inflammation and the scary things that can get people hospitalized. So, is there a different risk of infection or different risk of doing badly when you have the infection?
 
And as you already hinted, it's not so much about just having cancer as a label. I have to say, just to pick an example you and I were talking about before, someone who had Hodgkin's lymphoma 10 years ago and was cured. You know what? That person's immune system is almost undetectably different from yours and mine. So those people really don't have probably much of a different risk. But yes, people with active cancer, especially some of the blood cancers like lymphomas and leukemias can have a higher risk of just by having cancer. Because, just to pick one, CLL, chronic lymphocytic leukemia, those people can live in a pretty healthy way for years, maybe decades without even needing treatment, but their immune system is not quite normal. It's a little bit defective compared to an average immune system. Even though they normally don't get colds all the time, still there's a little difference.
 
So yes, just having cancer can increase risk of getting an active infection and it manifesting as a functional disease. But even more than that, it's about if we get the syndrome of fever, cough, even the bad things, pneumonia-looking X-ray, do cancer patients or lymphoma leukemia patients do badly with that? Well, they can, and that's not really always about the disease. It's about the co-morbidities that frequently go along with the disease. I'll just give one simple example. If you have a low immune system either from lymphoma, leukemia or from the therapies, we gave you a week or a month ago, then even if the virus doesn't treat you very differently, one reason people die from this virus or from every virus, influenza, still a very similar thing in many ways, they don't actually die from the virus, but they could die from, we say, bacterial superinfection. You get a little viral pneumonia. Even as it's getting better, you get normal bacterial pneumonia afterwards.
 
And it's just the normal immune system that we all talk about with our lymphoma patients, whose job it is to clear those bacterial pneumonias. And someone with a weakened immune system could get sicker because of that. So yes, people with active malignancies, active lymphoma or leukemia can be at some higher risk, but it's very much what you said, that it's frequently more of about recent therapies, chemotherapies or otherwise that they got. And, of course, not all therapies are the same. Some therapies have very little effect on the immune system, and some of them have profound effects. So again, it is an individualized thing.

Esther Schorr:
Okay. No, that's very helpful. So what that leads to is the question about if someone is in active treatment where they have been going to a clinic or a hospital, say for an infusion, or even if they're on maintenance, or they're going in for routine checkups, how does one assess whether it's safe to go to the hospital for either that treatment, or a routine scan of some sort, or blood work? What's the discussion there?

Dr. Brody:
Absolutely. So, this is a nuanced discussion, but we give you the big principles of it, so you can see it's not mostly rocket science. It's mostly understandable stuff, and it's a risk-benefit analysis for every patient. So let's just pick a couple of examples, paint by example instead of giving you the rules. The example is a person that is basically in good health that let's say has an indolent low grade follicular lymphoma for example, and they've been getting surveillance scans every six months, or 12 months, or something like that, and they've had a low disease burden, so they don't need therapy. Now whether they never needed therapy, they're previously untreated, or they got therapy a couple of years ago, and we're just keeping track of how they're doing. We are pushing off all of those scans and routine blood work, pushing them off for weeks. And we may end up pushing them off for months.
 
And we'll be completely honest here. You're getting behind the curtain now. And when we told you routinely we do these scans every six months, it was a little bit arbitrary. It could have been seven months. Now you caught us. The six months was not a hard and fast rule. It's a rough estimation of what we'd like to see in keeping track of someone's low grade lymphoma. And these rules for follicular lymphoma are almost identical to the rules for CLL in terms of monitoring. Same idea of a low grade lymphoma leukemia, which usually continues at a standard rate. If it barely progressed last year, it will probably progress at the same rate this year. So, if we scan you a month later or even two months later, it's probably fine.
 
We are encouraging all those patients to not come to the hospital for their routine visits and their routine surveillance. So that's one example. Let me just give the counterpoint, someone with aggressive lymphomas, and just paint the obvious and dramatic examples of that. Burkitt's lymphoma, a very aggressive lymphoma, or even the highest incident lymphoma, diffuse large B-cell lymphoma. Patients who are actively getting therapy for those lymphomas, we think the risk-benefit analysis is a no-brainer. Those pieces should continue their therapy. If we're talking about standard up-front, we say induction therapy, their first few months of therapy, there were questions about maybe some maintenance therapies. We address that in a third column.
 
But people getting therapy, the risk of breaking that recipe, and I should have emphasized, these are some of the aggressive are highly curable diseases. So Burkitt's diffuse large B cell lymphoma and Hodgkin's lymphoma are highly curable diseases. We cure the majority of people, and the chance of dying from the disease if we don't give you adequate therapy is high. It's actually much higher than the chance of dying from coronavirus. So that risk-benefit analysis is you should keep coming for your therapy.

Esther Schorr:
Okay. No, that's helpful. So actually, Dina, who is listening now asked a very good question. So, it's a good follow-up. She's an immunotherapy patient, and she's supposed to start in late April. So the question is should that be pushed out?

Dr. Brody:
Sure. There's still nuanced there. I'll give you a couple of examples of our patients on immunotherapy. Maybe she means anti-PD1 antibody like nivolumab (Opdivo), pembrolizumab (Keytruda), which are common therapies, especially for Hodgkin's lymphoma. And there still it does make a difference. So I'll just give you two versions of that. We have a patient with high burden Hodgkin's lymphoma, and that could harm them in the near term. They have a lot of tumor in their chest now, and anti-PD1 antibody can induce remissions quickly over the course of weeks and months. So we would feel safer if they didn't have a large tumor right now in their chest. So, we would start treating them now.
 
We have other patients who have been on anti-PD1 antibody for Hodgkin's lymphoma for eight months, 12 months even, and their lymphoma has shrunk 80 percent, 90 percent, and we're not sure exactly if you have to keep up the therapy at the same frequency. So we are pushing a lot of those patients off and saying, "We're not stopping your therapy, but let's push it off by two weeks then four weeks and see how it goes." If Dina is starting therapy, it's usually because we are more concerned about that cancer, presumably lymphoma, or other cancers similarly hurting her in the near term than the chance of coronavirus hurting you in the near term. So, if she's starting therapy April 1st, I would suspect without knowing the details that she probably should keep pushing it.

Esther Schorr:
Yeah. Very good. So then a follow-up to that is Andrea wonders if the risk benefit, you're talking about this analysis of the virus versus what needs to be attended to and the disease varies whether you're in a hot spot like you are in New York City, or you're somewhere else, for example, where we are in Carlsbad, California, it's easy to be six feet away from somebody. It's easier to stay in place even for your normal daily life.

Dr. Brody:
Yeah. Let me answer it, and I'm even going to go backwards and give Dina one more answer as well, which is if we're talking about anti-PD1 antibody, because she'd probably want to hear about this half of it as well, overall those therapies are not immune depleting. You can hear their function more so is to increase the efficacy of some immune cells. So, we do feel a little safer certainly about anti-PD1 antibody, which I'm guessing is the immunotherapy she's talking about, than we feel about lymphodepleting chemotherapies, your common R-CHOP and other versions of chemotherapy. So we do feel more comfortable with immunotherapies overall.
 
Does the risk-benefit analysis depend on hotspots or where you are, Carlsbad versus Manhattan? Absolutely. My only concern there is that these hotspots are going to change quickly over time. And when New York is going to be on the convalescent curve in a month or two, there's going to be some other cities which are on their way up. And I don't want to be scary because I have a lot of happy things to say about how we're doing this, but there are scary things too.
 
We won't know where the hot spots are until that hot spot is many weeks into being a hot spot. But again, it's the more densely populated places just seem obvious that they'll be the hot spots first and in places where it's easy to stand six feet away from each other, because you don't need a subway to get where you're going. I think those things will naturally not have the climactic and horrible circumstance we've had, because again, the goal is not for no one in America to ever get infected. Really the ideal goal is to get young, healthy people infected and cured. They get naturally immune just like we do with other viruses, so they can create herd immunity.
 
Some people hear that phrase around. Let me just make an anecdote of what that means very simply. In Manhattan, if you have a bus full of 20 people, and there is a person infected in the front of the bus, and there's a 75-year-old person with bad lungs, COPD in the back of the bus, if you had 18 young healthy people who are already immune to the virus because they had it a month ago, that would be very helpful to that person in the back of the bus. That's what herd immunity is, and similarly with other viruses, same thing with coronavirus. And although we don't know for sure that it's exactly as we say, this virus is not completely novel. It's not very different from SARS from eight years ago.
 
So, we think we have some basic understanding of it, and herd immunity would still apply. So yes, the risk-benefit analysis depends a lot. And in Carlsbad, my threshold to have someone come in to keep a track of their blood work would be a little lower than here in Manhattan when we're discouraging people and trying to push it off for them. Absolutely.

Esther Schorr:
Okay. So you mentioned younger versus older patients. So I know that the vast majority of Hodgkin lymphoma patients are younger. And I know some of this is evolving as you're looking at data. Is it still true that younger patients have an easier go with the virus? So if that's true, is that also true of the Hodgkin lymphoma young patients that you're seeing?

Dr. Brody:
Yes, absolutely. And I don't want to speak above the data we have, and a lot of the New York data is still being tallied. But let me say in the world, and this is so critical to take lessons from everywhere we can; I would say the best captured and reported data is from the South Korean experience. And they have a very beautiful data set showing that the mortality rate, the case fatality rate of people that got the virus for people under 30 was 0 percent. Now that doesn't mean it has to be truly zero. If you had a thousand or a million people, maybe it's 0.01 or something, but that's pretty good data in a number of young people that got infected and got hospitalized, and 0 percent of them died in that group. And it was a pretty good group, 170 people that they were measuring. Whereas 30 to 40 the case fatality ratio got to be like 0.1 percent, 0.14. So, it was something like one out of a thousand people that got the infection could die from it.
 
That's serious, but it's still 999 people who are doing okay. And then really above 50 it started to decline precipitously. So absolutely we do think age makes difference. That's South Korean data. Are Americans different? We are a little different. We're probably a little chubbier. We're probably in less good health in many ways. But the concept I think still does apply. Younger people do seem to do better, and we certainly have plenty of anecdotal experiences of young people that got tested for some reason and never had any symptoms at all, and then days later then could test negative and never manifested an illness. So anecdotally and by the data, it seems to be that being young makes a difference. I can answer the Hodgkin's question, but you have another question.

Esther Schorr:
No, no, no. The Hodgkin's question, please. What I'm hearing, and I don't know if I'm interpreting this right, is that it's really that age variable more than whether you have Hodgkin lymphoma or you don't that is more relevant.

Dr. Brody:
Yes. So when I talk about Hodgkin versus non-Hodgkin's, the vast majority of that is about age, but there's a little other nuance there as well. Hodgkin's people are mostly younger, but we do have a second incidence of Hodgkin's in the 60s, so that's not negligible. So I don't want to say that Hodgkin's is fine, but yes, young people do better. The difference with Hodgkin's is, as I mentioned, it's a highly curable disease. We cure overall more than 80 percent of it. And even for advanced stage patients, we probably cure well more than 70 percent of it. And when you can cure a young person and they can live for 80 more years and have a productive happy life, we feel compelled to really try to get people their therapy and even try to push them to stick with the recipe of the therapy and not delay things too much, especially if they're in the parts that we know are critical, the early part of the therapy. There are some maintenance therapy things where I'll make a bit of an exception.
 
So yes, we think that those people are at less risk. That affects the risk-benefit analysis. And we do think that they should, especially if they are in induction up-front therapy, be pushing ahead and trying to get it. We can be flexible. We can push things by days. People can travel because they are stuck in Florida, and then they'll get a plane back. Pushing things by days is always fine, but we would like to avoid pushing things by weeks. So yes, Hodgkin's has those particular differences of the demographics, people being younger especially, and the fact that we do want to push ahead with their therapy.
 
I'll mention one other thing here, which is we have different ways of treating Hodgkin'sThe standard, classic way has been with a regimen called ABVD, and now a newer approach that we think might be better, but it's controversial, something called AAVD. The B in ABVD, bleomycin (Bleo 15K), can have a weird lung toxicity called pneumonitis, and so much so that if we have a patient who's a smoker or we think may be a smoker and denies it even though we smell smoke on them every day, we sometimes won't give them the bleomycin, because that compounded toxicity is scary to us. So it might be a similar story here with coronavirus, because it primarily is a lung infection. We haven't had a lot of instances of that, but that kind of thinking could be distinct for Hodgkin's versus non-Hodgkin's.

Esther Schorr:
Okay. I just wanted to stop a second and remind people who are listening that in your Q&A at the bottom of your screen, if you have particular questions you'd like us to address, I know Dr. Brody is addressing a whole range of things that we're asking, but if you have some additional ones, please write in, and we'll see if we can get those answered. So we did get another question then to follow on about different kinds of treatment. What about transplant? For example, I know CAR T is being used in some forms of lymphoma, and there are different kinds of transplant treatments. Can you speak a little bit about what are the considerations related to that as a treatment?

Dr. Brody:
Sure, absolutely. So, transplant, we have autologous, giving it to yourself, stem cells, and allogeneic, getting stem cells from another donor, a relative or otherwise. Transplant and CAR T have one big similarity, which is they are intensive therapies where people's immune systems can be low for weeks and weeks, and sometimes in some ways months. So that's a consideration. If you have two options, you're deciding right now between CAR T and some other therapy which is also promising, we are trying to minimize, I'm sorry, let me put the other obvious thing there, which they are both therefore inpatient therapies, therapies in the hospital, and they require you to be in the hospital. So, both from the patient's side and from the doctor's side that could push the risk-benefit analysis.
 
Some patients we say in some ways need the transplant; they're in some dire situation where this is the only sweet spot opportunity to get them to transplant, and they need it, and we factor that in. But we have some patients who have relapsed-refractory DLBCL, diffuse large B-cell lymphoma, and it's aggressive, but nothing's going to happen too much in the next weeks or month. And we have to a reasonably good therapies, CAR T or something else. We have other recently approved therapies like polatuzumab vedotin (Polivy), or lenalidomide plus rituximab (Revlimid plus Rituxan), or new therapies that are about to get FDA-approved soon. And they're still promising and pretty good therapies, which would be less immunosuppressive for a less amount of time. Although we were going to maybe give them CAR T, and if it didn't work, give them polatuzumab, we could switch it around and give them the polatuzumab. And if that doesn't work in four weeks or eight weeks, then give them CAR T then.
 
So, it does affect our thinking. Those are inpatient therapies, and they are very immunosuppressive, and even not even from the patient's side, from the doctor's side. The inpatient service here in New York is extremely difficult and stressed just trying to take care of all of our patients. While coronavirus patients are completely separated from everyone else, still a strain on the system, the number of nurses that are working double shifts and working incredibly hard, we would like to avoid extra hospitalizations if we can.

Esther Schorr:
So then, the inpatient situation is much more intense and has the concern about transmission and all that. Where do the oral medications fit in? I know there is some concern about not just is there an oral medication that I could switch to, or just the access to oral medications. Can you speak a little bit to that and whether there's a concern about getting those medications if they're appropriate?

Dr. Brody:
Sure, absolutely. A highly relevant, both of those issues you brought up, using it as an alternative or access to the medicines. So I'll do the access to the medicines first. Although there are scary concerns about shortages of especially coronavirus relevant medicines, a famous one is hydroxychloroquine (Plaquenil), because there is a potential that it might be an effective therapy. It's a pretty soft potential. Maybe hydroxychloroquine plus azithromycin (Plaquenil plus Zithromax or AzaSite), a doublet therapy might be better based on some very early data. Some of those medicines are going on shortage immediately, and people that need those medicines for things like lupus are hard-pressed to get them. But those shortages are not really relevant for most of our anti-cancer oral therapies. So, we did not envision a difficulty in receiving those medicines in terms of access, in terms of supply, or in terms of shipping.
 
We think FedEx is going to keep being FedEx for the time being. In fact, FedEx is probably going to be much busier for the time being. And we don't think that we'll outstrip their ability to make, produce, supply and then deliver those oral therapies. So I don't think that we are worried about that at all. I know an anecdote of a good friend of yours who got a 90-day supply of an oral medicine recently. We think that 30-day supply will still get you covered, and there will be another 30-day supply thereafter. But just as said, we sometimes do have two comparably reasonable options. An inpatient or an infusion center therapy, I just mentioned polatuzumab vedotin for DLBCL versus Revlimid, and the Revlimid also is sometimes given with rituximab, but there where rituximab is just once a month, so fairly simple and brief. And so, the pill might be a preferred upon option for now. 

Esther Schorr:
So you can sometimes go back, and there's the ability to transfer safe from if somebody was scheduled originally to have chemotherapy, there is the possibility with these illnesses to go to an oral therapy? Is there enough leeway there?

Dr. Brody:
Yes, preferably when we're deciding to start one, not that we're in the middle of one therapy and want to switch, because switching in the middle of therapies can be very tricky. The real problem with that is you don't know if that therapy was helping you or not, and you're not sure if you can safely go back to it afterwards. And we sometimes burn a bridge by interrupting a therapy in the middle. We'd like to avoid that. But if we're starting a decision today, A versus B, and B as an oral therapy, absolutely. Sometimes equally reasonable and sometimes more convenient to take the pill at home.

Esther Schorr:
Okay. So we've covered a lot of ground. I wanted to, with the last few minutes we have there, just some general questions that we've tried to have answered for different conditions. And I wanted this audience to be able to hear those answers as well. So one of the big questions is, "Okay, I'm at home. I'm not allowed to leave. Or if I leave, what should I be doing? If I have to go out, should I be wearing a mask? Should I be wearing gloves? And then when things come to the house to be delivered, are there any standards now for how do I handle those deliveries?" 

Dr. Brody:

These are the everyday, scary things that people are worried about, and they should be scared, not because most people are going to be harmed by this, most people are not going to be. But if we scare all 100 people, then we might save the one who was really at risk, and we've just scared the other 99 accidentally, and I don't know; anxiety builds character maybe. Or that's what my parents used to tell me. So people should be scared and thoughtful, or at least thoughtful for sure. So let me give a punchline answer to some of those questions. Should we be wearing masks? If you are immunosuppressed because you recently received chemotherapy, you should be wearing a mask anytime you leave your home, unquestionably. Let's just say while people are scared of the hospital a little bit because they associate illness with the hospital and even disease and infection, the hospital is a much more controlled environment than the grocery store where you still do need to go.
 
We don't want people to starve to death. The grocery store, if the avocados are unclean, you can't alcohol all of them, and you're going to touch things in the grocery store which we cannot sterilize, where in the hospital, that room is functionally sterilized, and we can put gloves over everything and masks. So if you're recently treated with chemotherapy that is immunosuppressive, which many of them are, you should be wearing a mask when you leave the house. If you have a high burden lymphoma or leukemia types like CLL or follicular lymphoma. Even if you haven't gotten recent therapy or even if you got chemotherapy three or four months ago, your immune system still may be not at optimal ebb, and therefore you should wear a mask.
 
For all Americans, should we all wear masks? I think Anthony Fauci is going to make new decisions about that each day. Are there enough masks? I don't know. When I am in the clinic, I wear a mask all around the clinic. When I go across Central Park to my apartment, I don't wear a mask, because I'm more than six feet away from everybody. So we can still pour common sense on this problem, and it will dissolve some parts of the problem. What do you do with packages and deliveries? Coronavirus can live on inanimate objects, some more than others, and it can live there on wood, plastic and metal for hours, not for days.
 
So, if you get a box and you're anxious about it, you can let it sit there for a day, and it is now sterile of virus, or you can use alcohol on parts that you have to touch. Or if you're really anxious about it, put on a pair of gloves, cut it open, take the innards out. So we can pour common sense on some of these things. But most, most, most coronavirus is transmitted only by, we say droplet particles being within a breath’s reach of someone else, especially if they're coughing or sneezing. That is the vast majority of transmission of this virus.

Esther Schorr:
That's really, really helpful. Thank you. We have time for one other question in an area that we haven't touched on. Some of our viewers may be in a clinical trial or are being considered to be in a clinical trial. I know that the policies around what to do with clinical trials in this pandemic situation are shifting, but are you aware, at least in the area of lymphomas, what are some of the considerations about somebody who's already in a clinical trial, whether they can be switched to some at home administration? What's being talked about, and what questions should be asked?

Dr. Brody:
Yeah, it poses questions, because people think it might be different. But the truth is the algorithm, the way we think about it, it's very similar. If they are urgently in need of this therapy, clinical trial or standard of care, we continue the therapy. We don't interrupt it. If there are extra monitoring visits that they need, because we like to monitor a lot on clinical trials, we are bumping some of those. And if they're coming in weekly for labs but we think that really their labs have been quite stable, we're bumping a lot of those visits. And if it's a pill, sometimes we can FedEx the pill straight to their house, and they don't need to come. But we don't want to interrupt therapies, clinical trial or otherwise, because this could affect the efficacy of the therapies.
 
We're running low on time, and I promised you that I would say something happy. I'll say at least two quick happy things. My buddy who is a doctor here, his 95-year-old grandpa got discharged yesterday after being in hospital for a week with coronavirus. He's at home; he's doing pretty well. And, of course, we have many others like that. But the 95-year-old I think is a particularly telling story. The virus is dangerous but not universally lethal. Most people do well but just not enough people. And the more exciting thing is we can use our understanding here to make therapies. We are working on building vaccines, we, the community, the scientific community. And even here at Mount Sinai we are building a more immediate therapy, which is taking serum from people who have convalesced, who have made an immune response to the virus, and treating other people with that plasma. So in China, we already saw a few people get great benefits from this therapy, and we're just starting it up now here. So we can use our creativity to hopefully solve some both emergent and long-term problems.

Esther Schorr:
So it does sound like from your perspective as a researcher that we can feel pretty confident that lymphoma research is continuing to move forward; it's not on hold.

Dr. Brody:
It is slowed down a little bit, but it is definitely pushing forward, and we're making some progress.

Esther Schorr:
Great. Well I want to just, on behalf of all of us, wish you well, especially in New York City. And I want to thank you and your colleagues. You are angels. And Mount Sinai is a leader in this plasma research, and I'm sure that as the coronavirus problem gets resolved, that you guys are going to be front-runners in trying to help these communities as well as the rest of the globe deal with this. So here's a round of applause for you and for all the other healthcare people that you work with and all the global people that you're coordinating with. So I just want to say on behalf of Patient Power and all of our community, thank you; thank you. And hopefully we will talk with you again, perhaps in another couple of weeks where there's even more information and more hope. So, Dr. Josh Brody, thank you again, and to all of you there. This is Esther Schorr from Patient Power to remind you that knowledge can be the very best medicine of all.

Please remember the opinions expressed on Patient Power are not necessarily the views of our sponsors, contributors, partners or Patient Power. Our discussions are not a substitute for seeking medical advice or care from your own doctor. That’s how you’ll get care that’s most appropriate for you.
 
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