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Myeloma Experts Discuss Coronavirus and Impact on Patient Care

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Published on April 28, 2020

Key Takeaways

Does your myeloma treatment plan need to change in light of the coronavirus? If so, how? And what does immunocompromised mean? We asked these questions and more to a panel of leading myeloma experts during our recent virtual town hall meeting.
 
Watch as they explain why myeloma patients are at increased risk for infection and what healthcare providers are doing to protect their patients right now, including the use of telemedicine. They also share several ways doctors are modifying treatment plans during this time, and explain why delaying a transplant, switching to oral medications or reducing supportive care therapy might occur.

This program features Dr. Frits van Rhee and Dr. Guido Tricot from the University of Arkansas for Medical Sciences (UAMS) Myeloma Center, Dr. Shebli Atrash from Levine Cancer Institute of Atrium Health, and host and patient advocate Maddie Hunter.

This program is sponsored by Takeda, Janssen and Karyopharm. These organizations have no editorial control, and Patient Power is solely responsible for program content. It is produced by Patient Power in partnership with UAMS Myeloma Center

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University of Arkansas for Medical Sciences Myeloma Center

Transcript | Myeloma Experts Discuss Coronavirus and Impact on Patient Care

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.

Maddie Hunter:
Let's start on our journey here with talking about why we're meeting virtually. I was so disappointed that I wasn't going to get to come to Arkansas to do this event in-person, and the virus has sort of thrown a monkey wrench in so much for all of us. We're going to spend a few minutes talking about that virus, since it's so front and center for us. If we could start with Dr. Van Rhee. Dr. Van Rhee, do myeloma patients get coronavirus? And if so, how do they fare?  

Dr. van Rhee:
Patients have been infected and obviously this pandemic presents unique challenges for our myeloma patients. They worry about their treatment, they worry about getting infected, and they can indeed contract the virus. And we do know that patients who are immunocompromised are at increased risk of getting a more severe infection. And obviously, we need to guide them through their treatment journey and at the same time protect them and also obviously deliver the best possible therapy under the circumstances.
 
Maddie Hunter:
Dr. Tricot, for those of us who have myeloma and are immunocompromised, can you talk a little bit about what does that mean that we're immunocompromised, and why does that make us vulnerable for the virus in general?

Dr. Tricot:
Immunosuppressed means that your immune system is not working properly, and that's a challenge in mounting a good response to any type of infection. Patients with myeloma, because of the myeloma, but also mainly because of the treatments, are typically immunosuppressed. They don't make antibodies as much as other people do, and their T cells are also not functioning well, so they are at higher risk of developing problems. And if they had, in addition to that, other complications such as diabetes or hypertension or they are overweight, 
they will be even more at risk.

Maddie Hunter:
So, it sounds to me like the disease itself makes us compromised and vulnerable now. And I guess I'm wondering, Dr. Atrash, what are some of the strategies that we can use no matter where we're living to help mediate our risk to having some bad result from the virus?
 
Dr. Atrash:
What we are doing in Levine, we are moving towards all video platform. For patients who have high risk, who need to get chemotherapy urgently, those patients must be seen in the clinic. For patients who are receiving maintenance treatment or low risk disease or a smoldering myeloma, what we are doing is virtual clinic visits. 
 
We divide our teams for the physicians into two teams, team A and team B. And therefore, one doctor will be covering for all other physicians. The idea behind that, if one healthcare provider gets sick or gets infected, that healthcare provider will not be spreading the disease as well. It's a challenging scenario. We have a lot of patients with asymptomatic infection, which can be a carrier for other patients.
 
Maddie Hunter:
It's interesting that you're using that 
telemed platform. I'm hearing that across the board. My own physician in New York City uses that now with me. But Dr. Van Rhee. I'm wondering are there other things, are there other changes to how therapies are being offered now because of the vulnerability that we have towards the virus? 
 
Dr. van Rhee:
We can make modifications in how we approach our patients. In terms of transplant, some of the patients have lower risk disease. We can delay the transplant and give them a combination of drugs to control the disease prior to proceeding to transplant. There are also different treatments that we can give, a prime example, for instance, is that there is an oral proteasome inhibitor called ixazomib (Ninlaro), which can be used instead of the drugs which are given subcutaneously or intravenously. There are also oral options now for the patients who have relapsed disease, so we can modify their treatments accordingly.
 
Obviously, it's also important to realize that there are some patients with more aggressive disease. And people who do get and who do need more intensive therapy, we tend to deliver it more as an inpatient and keep them safely in the hospital rather than bringing them backwards and forwards to our outpatient chemotherapy and transplant area.
 
And then there are also some treatments of which we can reduce the frequency such as the bisphosphonate therapy and other supportive care measures, it can temporarily either be suspended or not be delivered as frequently.
 
And again, we must make all these modifications really on an individual basis. I'd like to look at every patient individually and see what we can do to deliver them, the safe and the 
best therapy under the circumstances.
 
Maddie Hunter:
Well, what's exciting is that there are so many options to just keeping people safe as you described. 

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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