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COVID-19 Lessons for Myeloma Patients

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Published on July 1, 2020

COVID-19 Lessons for Myeloma Patients

Myeloma patients are still at risk from COVID-19. With recent spikes in Arizona and other parts of the country, what can patients do to stay safe?

Patient Power Co-Founder Andrew Schorr speaks with Dr. Rafael Fonseca from the Mayo Clinic in Arizona about the coronavirus pandemic and what cancer patients should be doing to protect themselves. Dr. Fonseca also explains how different drugs may play a role in COVID-19 treatment.

Please remember, even if you are a patient with access to some of the drugs discussed in this program, you need to consult your doctor before using them for anything other than their prescribed reason.

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Transcript | COVID-19 Lessons for Myeloma Patients

Andrew Schorr:
Hello, Andrew Schorr here with Patient Power in Southern California. Joining me in this time of the COVID-19 pandemic from Arizona, where a lot's been happening as we do this interview, is Dr. Rafael Fonseca, who is a world-renowned myeloma specialist based at the Mayo Clinic in Scottsdale, right there next to Phoenix. Dr. Fonseca, so myeloma patients, often older, feel vulnerable having the myeloma, and now there's a high incidence, unfortunately, right now of the COVID-19 disease. What are you telling your myeloma patients? Because I'm sure they're asking you, doctor, how can I stay safe?

Dr. Fonseca:
Sure. Well, thank you, Andrew. First of all, this is a very, very important question. I think it just stands to reason that one has to be extra careful when, in addition to perhaps some other factors that we can’t control like age or some of the other comorbidities that one might have that could make a potential COVID infection be worse, that there is a possibility that, for someone who is already dealing with a form of cancer, who's dealing with the treatment for that cancer, that that may pose an additional burden on that person as they try to fight off that infection. Now, the reality, and I think this is very important because patients will see a lot of this out there in the news, every single case is different. So if you think about a myeloma patient, but it turns out they have smoldering multiple myeloma and they seem to be healthy and otherwise, their health is in a reasonable situation, one would have to think, and without knowing 100%, that it is quite likely that they probably would have a similar outcome if they, unfortunately, became infected with COVID.

Now, on the other extreme, if we take someone who's already greatly debilitated or someone who has pulmonary disease or perhaps other cancers as people have, lung cancer and the like, that would be a more risky situation. So knowing that we don't have the full knowledge about the spectrum and how people will respond, I just tell my patients that they shouldn't be extra careful as they engage in their daily activities. Now, we know now that it appears that most of what we see for infection is from human to human, and accordingly, there's pretty good data that I think supports the general guidelines that we're seeing from health authorities and others with just physical distancing.

That's important. Someone made the distinction the other day for me is that it's physical, it's not social distancing. Because you can still be interacting with others, just keeping that distance if you have to, or if it's part of your family. But as you just pointed out, the use of masks is essential too as well. So those are the two key things. The mask component, of course, is a community effort to decrease the spread, particularly because of containment of particles that could come out during the process of either a conversation or coughing or sneezing for someone who might be infected and doesn't know that yet. Are they perfect? No, there's no mask that is 100% perfect. But what we're trying to do is trying to contain the likelihood that that person would spread it. So I personally am a strong believer in that. I use it when I go outside. I think if we all do our part, that's going to help the community.

Andrew Schorr:
Right, so I just want to go over a couple of things with you. So someone with a myeloma diagnosis, and it could be at a lot of different places, smoldering, maybe even MGUS, or advanced myeloma and they've had many therapies and they have comorbidities, what you're saying is how the virus might affect them will vary based on their health, comorbidities. There's not a single answer that everybody with a myeloma diagnosis is going to react the same way. It'd be just the opposite, what I hear you saying.

Dr. Fonseca:
Correct. Every single case is different. So what I would say the way you approach it, I don't think you need to go out and call your doctor right now. Be careful, be attentive, follow those guidelines for safe behavior. In the unfortunate situation, if someone were to be known positive, then engage in that conversation. So you don't necessarily have to go through all the what-ifs, so you can engage in that conversation and decide what's the best next step for your care. Now, it would be interesting to say, I think, and hypothesize that we don't know the full effect of all the drugs and how they might potentially affect the outcome of someone who's infected. It's possible that certain drugs at some points may be harmful, perhaps some of them are beneficial.

We have discussed that there's a recent paper that suggests that the use of dexamethasone (Decadron) may be effective, but it's critically important to say that it is only effective in those that require oxygen supplementation. For the most part, you see most of the benefit in patients who are intubated. Now, a lot of patients in the audience might be thinking, "Oh boy, I have dexamethasone in the cabinet." I think going and just taking that without having any one of the conditions, that oxygen requirement, is probably a bad idea because dexamethasone can also potentially decrease your ability to fight off an infection. So I would say, always talk to the doctor and there's interestingly, a number of medications that are used for the treatment of myeloma and other hematological conditions that are being part of the clinical trials that are being brought against COVID.

Selinexor (Xpovio), ibrutinib (Imbruvica), monoclonal antibodies against IL-6 like tocilizumab (Actemra), and the first clinical trial to be positive was of dexamethasone. So it's right there in the toolbox of what we do for hematology patients, but it has to be done under expert supervision and guidance.

Andrew Schorr:
Okay. Well said. Well, there you are in Arizona. We're all facing the worries about pandemic and doing what we can; the masks, the handwashing, the physical distancing, and just thinking smart. As you just pointed out, not using a medicine inappropriately, so if you've heard on the news, maybe it could work related to the virus - talk to your doctor. Dr. Rafael Fonseca, we wish you all the best in Arizona. Thank you for sharing your experience with us today.

Dr. Fonseca:
Thank you for the time and the opportunity. Always a pleasure.

Andrew Schorr:
Okay. I'm Andrew Schorr. We wish you all well. Knowledge can be the best medicine of all.


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