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Your Questions, Expert Answers: Managing Myeloma During the Coronavirus Outbreak

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Published on March 20, 2020

Key Takeaways

"Immunocompromise is real, it's present in myeloma patients and that's why I think myeloma patients are at higher risk for having complications from this virus," says Dr. Nina Shah while discussing the potential impact of COVID-19 on those living with multiple myeloma.

What do patients need to know about coronavirus? During this Ask the Expert program, Dr. Shah and Dr. Larry Anderson take questions from the myeloma community and share specific precautions to help reduce their risk of exposure.

Tune in to hear expert perspectives on questions like; "Will I continue my regular treatment or clinical trial protocol? What if I'm scheduled for a transplant? What do I do if I'm in close contact with family? What symptoms should a myeloma patient be looking for?" 

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Transcript | Your Questions, Expert Answers: Managing Myeloma During the Coronavirus Outbreak

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.

Andrew Schorr:
Greetings, it's Andrew Schorr in Southern California. Welcome to our program. And we're going to take your questions for noted myeloma experts. And so joining us from San Francisco is Dr. Nina Shah. She'll pop on her video there. And—there she is. Thank you for being with us, Dr. Shah.

And also joining us…

Dr. Shah:
Thanks for having me.

Andrew Schorr:
...thank you. And also joining us is the head of the myeloma program at UT Southwestern in Dallas, that's Dr. Larry Anderson. Dr. Anderson, thank you so much for being with us as well.

So, we are in interesting times I would say and so the number one question that I know we're all wondering about, people affected by any cancer for sure, because we kind of figure we're in the 20 percent who may be at higher risk. And on the news, they talk about people with cardiovascular conditions and diabetes and asthma and maybe COPD, et cetera, but they don't always break it down in cancer. But this program, we want to do that. So Dr. Shah, I'll start with you. Are myeloma patients at higher risk for the coronavirus?

Dr. Shah:
Yes. First of all, thank you so much for having me today, and I hope we can provide some useful information in a very confusing time. I want to start off by saying a lot of these things are our opinions, and it's hard to know because, of course, we thankfully haven't had to fully live through this just yet.

My personal opinion is that anybody with a compromised immune system is at risk. And, in my mind, all myeloma patients have a compromised immune system, kind of how they got the disease in the first place, because their immune system wasn't working enough. And to add to that, many of our patients are on things like dexamethasone (Decadron) or daratumumab (Darzalex), which decreases the body's immune system ability to fight against viruses.

And ultimately, it's the number of virus particles and what we call the viral load, which is going to determine symptoms. So, in my opinion, yes. Immunocompromise is real, it's present in myeloma patients, and that's why I think myeloma patients are at higher risk for having complications from this virus.

Andrew Schorr:
Okay. Dr. Anderson, so some of the myeloma medicines are infused so you go to the clinic on some regular schedule, but yet if you're immunocompromised you say, "Should I go? Should my schedule change?" And Dr. Shah's in San Francisco where people are really locked down to some degree. So, what are you telling your patients who are on active therapy and infused therapy?

Dr. Anderson:
Sure. Right now we're having most of those patients that are getting active infusions go ahead and proceed and come on in for their infusion, especially if they're on active therapy and not in stable long-term remissions. If they've been in remission for a long time and just getting a maintenance infusion, we're considering canceling those. Especially in all these patients that are on oral maintenance therapy and very stable, although we continue their maintenance, we're definitely canceling a lot of their monthly labs and follow-ups this month just to avoid their exposure in the waiting rooms here. 

But for those that are getting active therapy with infusions, most likely would still want to proceed. But certainly something to talk to your myeloma team about to see if they think that you're someone that could skip or delay. But the problem is if we delay everything a month, we don't have any idea what next month will bring. It could be a lot worse a month from now, whereas right now, we're just now starting to get a few cases in Dallas, but it could be a lot worse a month from now.

Andrew Schorr:
Okay. Dr. Shah, you're in a dense city there and so people are worried about going out. Maybe they're on oral therapy. So what about the oral therapies? Should they continue those just on a regular schedule?

Dr. Shah:
Yeah, actually one of the great things about oral therapy is it was made to be patient friendly so that's a good thing. So people who are on drugs like ixazomib (Ninlaro) or lenalidomide (Revlimid), most commonly, we really do encourage continuing those. And many of those can be monitored with local labs. So many patients go to their local Quest laboratory and get labs deposited there. And then we can see those or get them faxed here.

And actually, we've been using a lot of televisits or video visits very similar to what we're doing exactly right now. And you can tell a lot from just having a video chat with a patient similar to what you do with your loved ones with FaceTime. And we've been converting a lot of those visits. So we've been essentially managing a lot of the patients with oral chemotherapy remotely for the past week. And it's been fine. Actually, some patients really like it, because they don't have to come and park in San Francisco. But I definitely think that's one of those chemos that we don't have to halt during this time.

Andrew Schorr:
Mm-hmm. Okay. Dr. Anderson, let's talk about family relations. So, okay. Right off the bat, Dr. Shah and you were nodding your head, myeloma patients are immunocompromised. Maybe they're in active therapy, probably are in some kind of therapy, and their husband or wife or Millennial kid or whatever, or even their grandkids, are out in the world. So what about precautions, what are you telling them about their family?

Dr. Anderson:
Yeah. So if they're in close contact with family, they really should have their family trying to minimize exposures and avoid crowds, avoid travel, or if they're going to travel out of state right now, I'd probably self-isolate for a couple of weeks to avoid close contact with a family member that may have contracted the virus.

Andrew Schorr:
Okay. Now, Dr. Shah, many people with myeloma are older, not everybody but a lot, have grandkids. A hug from a grandkid can be wonderful therapy. But what about that, the relationships with little kids?

Dr. Shah:
Yeah, I agree with what Dr. Anderson just said. And even as an example, our own community, so my doctor's community, my best friends who have elderly parents that we are in contact with, we have kept away from our parents. So not just the myeloma community as a patient being older than 60 or 70 but even the doctors are saying the same thing. So, my advice truly is, if you are elderly particularly, but even just having myeloma and you have family members, it's not fun but this is the time to socially isolate or distance as best as you can. And this might mean that you can't go to their house for the next couple of weeks, or they can't come to your house for the next couple of weeks, which is really hard. But again, using video chat or other ways is a good way to keep in touch. It's worth it for this couple of weeks of feeling distance in order to save your lungs potentially from a very difficult disease.

Andrew Schorr:
Okay. Dr. Anderson, so when to call the doctor, Dr. Shah mentioned about telemedicine. So what symptoms would a myeloma patient be looking for? Would they be any different? Would their immune response, would they get as high a fever as somebody who didn't have myeloma? Would the immune response be different? What should they be looking for when they call the clinic and whether it's going to trigger telemedicine checkup or whatever? What would you say?

Dr. Anderson:
Yeah, I mean the symptoms that we worry about with COVID-19 or coronavirus disease would be fevers, body aches, cough, shortness of breath, very much flu-like symptoms. And certainly if they're having any of those, would want to communicate with their team and see what the appropriate steps would be, whether that's the emergency room or some different option locally. If they're having sniffles or common cold symptoms, most of those patients, we're telling them to stay home and self-isolate, not necessarily come in for sniffles.

But, it's a fluid situation. It's changing every day, and every medical center has a different pathway for these patients. So they really need to check with their team if they're having any of these things. And as you mentioned, yes, some of our patients with myeloma may be on steroids that might mask fever, so they may not necessarily have a high fever like a regular person would have. But if they're just feeling rundown and achy and especially cough and especially shortness of breath, they would definitely need to get checked out.

Andrew Schorr:
Right. But, Dr. Shah, you don't want them to jump in the car. You want them to communicate with your office, right?

Dr. Shah:
Yeah. I think the first thing is to call the office and really tease out what the symptoms are and how urgent it is for you to have evaluation. I completely agree with Dr. Anderson that anybody who's having true respiratory symptoms has to be evaluated. And that might mean, for example, in our institution, coming straight here, but not coming to the clinic. Rather going to the screening area. Or at other places, there's drive-up screening more locally available. Like a patient may be my patient but lives three hours away, so we try to figure out resources in that way. But yes, it's really important as a first pass to do that phone call or that email message. We're doing really active, vigilant management of the inboxes right now exactly for this reason.

Andrew Schorr:
Okay. Dr. Anderson, some people have not full-blown myeloma, but they have sort of a precursor, MGUS, and they were getting some blood tests with regularity. Should that continue, or can they forego some of that so that they just stay close to home?

Dr. Anderson:
Great question. For those patients with either smoldering myeloma or MGUS, that have a precursor states, as long as their labs have been stable, they're not having new symptoms, we're pushing most of those out a few months, just until this viral season is over and not as big of a threat to them just coming and getting exposed to things in the waiting rooms. Even though we're heavily screening our patients’ visits and trying to avoid patients coming into the clinic with respiratory symptoms where there still could be exposure to asymptomatic carriers, and we don't really know yet the full ability of not of asymptomatic patients of shedding this virus and spreading it to other patients at this point. So anybody that's not having new symptoms, we'll just send them a message, say, "Hey, we're going to delay this a few months. If you don't have any new problems, we'll just see you in a few months."

Andrew Schorr:
Dr. Shah, let's go to the other end of the scale. Somebody was scheduled for a transplant, so does that get put off? What do we do about transplant?

Dr. Shah:
Right. That's a great question, because it, of course, as all things, case-by-case basis. But what we've been doing at least for right now is for people who aren't going to get a transplant but are pretty stable, maybe they're in a complete response, they got their cells collected, we're kind of holding off for the next two weeks for a couple of reasons.

One, we don't want to put them at extra risk of being around the hospital and potential exposures. Two, there may be a resource issue. And we don't want them to be in a place where they can't get resources—and by that I mean blood transfusion, ICU beds, et cetera. And three, they can wait. They don't want to come back and forth. It's not just the inpatient part of getting a transplant, but thereafter for months they're going to be immunocompromised. So maybe we can hold off on that immunocompromised timeline until we have a better control, epidemiologically over this virus.

So truly we don't know. Of course, just as Dr. Anderson said, it might be that in two weeks from now we're even worse. I am an optimist. I think you have to be as an oncologist. But I'm an optimist that with all the containment measures that we've had that maybe this'll start to peel back, and we have flattened the curve. And when that happens, then we will quickly take these patients to transplant. And just one thing about that, if we can do the stem cell collection, I like to do that now, because that's not an inpatient thing, and that's outpatient and I think worth doing, so that part has been taken care of.

Andrew Schorr:
That's a great answer. Dr. Anderson, some patients have chosen to be in a clinical trial for multiple myeloma, and we're blessed with a broad range of drugs and may be more coming—so yay to be in a clinical trial. But it may not be a clinical trial near them. They may be traveling. If, let's say, you had a clinical trial going in Dallas, but they live at some distance, hesitant to travel, will they be dropped from the trial? That's what Cindy Chmielewski just wrote in about.

Dr. Anderson:
Yeah. So most clinical trials during this epidemic are having special guidelines for patients to be able to skip monthly visits or labs, or just have their labs locally, and then we can ship them. There is study medication. At least some of those trials are allowing that. It depends on if it's an intravenous infusion, et cetera. So it really depends on the specific clinical trial that the patient is in. But I know at least some of the ones here that are on oral maintenance therapy, we're allowed to ship that drug to the patient as long as we think they're safe.

Andrew Schorr:
By the way, just today, and I haven't had a chance to read it, but there was a guidance for doctors in trial sites from the FDA, I think even today. So it's a moving target.

By the way, if you have a question, folks, you can put it, click on the little Q&A button at the bottom, and we will see it. But we've gotten many questions in advance.

So, first of all, about food. So here's a question we got. Considering takeout food, but I'm very nervous about my immune system being so compromised. Will heating up the food in the microwave kill any virus that unexpectedly made its way into my food, Dr. Shah? Any thought about that?

Dr. Shah:
So it's interesting. We don't think that actually the virus, again, this is all just what the recent research is showing, stays on, is really on food per se. Now, if somebody sneezed on your food, I guess that would be one thing. But really we're more concerned with aerosolized droplets, transmission, for example, from a sneeze or a call from humans to humans. So the risk of the virus being viable on the food is generally low.

That being said, take-out, and I know a lot of us are trying to do this to keep restaurants alive. And, of course, if you're ill you may not want to cook, so that's understandable. I think that microwaving is always a good idea. Heating things is always a good idea. I can't completely state this for sure, but I would be very surprised if a virus particle or virion, as we call them, would survive a good zap in the microwave. So I'd say that's probably a good thing to do, particularly if the food came a little cold, and it would taste better warm anyway.

Andrew Schorr:
Hmm. So, Dr. Anderson, though, this is a moving target, right? So there was something that came out, I think in one of your journals yesterday about how long the virus lasts in different kinds of surfaces, cardboard, plastic, metal. So what you've had to go on has been pretty limited, like Chinese data on what percentage of the patients were cancer patients, not necessarily even breakdown of myeloma patients. So you're trying to figure this out, right?

Dr. Anderson:
Yeah, it's definitely a work in progress, a moving target, fluid situation. Yeah, we do think that the virus could potentially stay active on surfaces for several days. So certainly want to keep your hand hygiene up frequently with either hand sanitizer and periodically with soap and water, just to make sure whatever you're touching on surfaces are not going in you. And no touching the face, easier said than done, but we're all trying to learn to do that better. Every time I think about it, my face itches, but yeah, the fomites or particles of virus on inanimate objects is something that we're concerned about too. I don't think we really know the full extent of how that is causing any more risk for our patients at this point, but something to be aware of.

Andrew Schorr:
Well, we'll be getting more data. Dr. Shah, so question came in from Tiffany, said, "Well, what time frame should we expect to self-isolate?"

Dr. Shah:
Generally we’re talking about, do you mean in generally for the population or if you've been exposed?

Andrew Schorr:
Well, let's talk about, first of all, for myeloma patients or a family member maybe who's been out and may—take us through it a little bit.

Dr. Shah:
I think that if there's been a known exposure, those patients or those people are asked to isolate for 14 days because that's sort of the time during which you'll know if you have the virus or not, because we're not necessarily recommending testing for asymptomatic people yet. If you're talking about general isolation for the population, we're not going to know any trajectory of that number until about a week from now or 10 days from now. Because truthfully, we've really only become the true isolation probably within the past couple of days, and it's going to take two weeks before we know who's really starting to get sick and when we ramp up our testing, we'll know for sure. Unfortunately that means I don't have a direct number to tell you, but I think you can expect this lifestyle for the next two weeks.

Andrew Schorr:
Whoa. Okay. Dr. Anderson, so here's a question that came in from a myeloma teacher, Cindy Chimelewski, who's our dear friend, "So, if someone must go out in public, if they can get a hold of one of those N95 masks, which I know you healthcare providers need," right? And there's been a short supply of that, "And they wear gloves, should they feel protected?"

Dr. Anderson:
Not necessarily. So, I mean if you're going out in non-crowded time and non-peak hours, it's probably fine. But viral particles could get through your eyes, could get on your skin. So it isn't necessarily a protection, that even wearing a mask on a plane was not going to be very protective. But mainly just avoiding crowds and a lot of hand sanitizing would be the goal. There is a little bit of data coming out of China with their experience with surgical masks may be protective even when normally we think about needing an N95 or something stronger, but it looks like surgical masks might have some decent protection more than we thought it would. But until this is over, I wouldn't trust necessarily just a regular surgical mask.

Andrew Schorr:
Dr. Shah, here's the question we got in from Jill who says, "Well, what do you recommend that we can do as myeloma patients to boost our immune system?" So exercise, diet, stress reduction, sleep, just what are the things that can help, what can patients do themselves?

Dr. Shah:
Yeah, I think this is a great question and one that I get even outside of the sole pandemic situation. In general, I am a big proponent of health, so is Dr. Anderson. And I actually think it's great for people to walk outside, and for example, even in the San Francisco area where we have a shelter in place, people are allowed to be out for exercise as long as you're six feet away from someone else.

So, this would be a good time to go take a walk on the track, maybe a hike in a slightly more remote area. Keep yourself healthy, because let's say for example, God forbid you had an illness, the fact that you have some pulmonary reserve is going to help you. Certainly not smoking, staying away from toxic exposures, that's also good, because we know that lungs that are damaged do poorly with the virus. So anything that you can do to change your situation to be healthier in a common sense way is the best thing to do. There's not really necessarily an immune booster we can recommend, just being as healthy as possible from what you already know in your head.

Andrew Schorr:
And immune boosters, so there's no shortage of stuff on the Internet offering you this deep secret that the medical community won't tell you or pharma won't tell you, but there's nothing proven, right?

Dr. Shah:
Well if there was, I'd be much richer than I am, but I don't think there's really anything that we can say and hasn't been FDA-approved, of course. The other thing is, my little patients are different, they've already demonstrated themselves to be immune-compromised, so it's not clear that any vitamin or any supplement is going to have that same effect even if there were one on patients with myeloma.

Dr. Anderson:
And actually, the myeloma cells are part of the immune system, so by definition the treatments that we give are targeting the immune system, trying to lower the immune system. So it's almost counterintuitive to give things that really boost the immune system as well.

Andrew Schorr:
Oh, okay. Dr. Anderson, Mark wrote in, he said, "Well, let's define a little more about self-isolation." So Dr. Shah was just mentioning in San Francisco, you stay close to home, but you can walk the dog or go jogging if you're not close with other people or whatever. How would you define that kind of self-isolation?

Dr. Anderson:
Yeah, so just as a preventive measure for self-isolating, yeah, mostly staying at home, avoiding crowds of, well at work here we're avoiding crowds of five people, at least avoiding, probably more than 10 people, family members, anybody sick. Not going to inside restaurants or busy, crowded shopping centers. Ideally if you have family members that are less elderly and more healthy, they could potentially go shopping for you and bring things for you, especially if they're not sick and exposed to coronavirus patients. Now if we're talking about self-quarantine for after exposure, then it's a little more strict and really not getting, not being around anybody else to potentially spread that virus.

Andrew Schorr:
Wow. Okay. Dr Shah, I know you have to go in a couple of minutes, and I just want to thank our volunteer physicians here. You can imagine how busy they are, how many calls they get, how much telemedicine they're doing, because everybody's asking them their questions, and hopefully we can reach hundreds if not thousands of people this way. Dr Shah, so if someone ends up being hospitalized for myeloma, what would you be doing that otherwise would be done at home? So, I understand supportive care first, so how would you treat them? So now you say, "Gee, Mrs. Jones, you need to stay in the hospital."

Dr. Shah:
For the myeloma treatment, not necessarily for the virus, right?

Andrew Schorr:
No, no. For the myeloma patient who is diagnosed with COVID-19.

Dr. Shah:
Right. So as you know, right now it's supportive care mainly, we don't have a FDA-approved drug, although one is sort of entering clinical trial now. And so, in that case we need to be very vigilant to, first of all, isolate that patient, but then provide adequate care. And so, that means that if there are oxygen requirements, if there's an ICU requirement, if it's just supportive care, even with acetaminophen (Tylenol) to break down the fever and things like that, in our hospital, patients, even if they have a cancer diagnosis, but their primary reason for admission is COVID-19, they're going to a separate floor where there's a specific COVID-19 infectious disease and pulmonary team rounding on them. So it's kind of like the work of the myeloma doctor has to pause for a minute, and instead we have to focus on the infection at hand.

Andrew Schorr:
Wow, and one thing before we let you go, we've heard a shortage of ventilators, but none of us are really familiar with what a ventilator is, and I imagine it gets used in the ICU. So, is this somebody where they have tremendous issues, and they're breathing themselves, and the ventilator is helping them breathe, is that the idea?

Dr. Shah:
Yeah, so a ventilator is a machine that essentially helps to A, deliver oxygen and B, pressure—the pressure that you need and the volume of air that you need to keep your body alive. And so, with this virus which likes to attack the little cells in your lung that actually participate in air exchange, so those are called alveoli, this virus likes to attack those cells. And so then it decreases the capability of your lung to actually exchange oxygen and carbon dioxide, so that's why these ventilators can be helpful. Hopefully we don't have a shortage. That's one of the things that is a real fear for all of us.

Andrew Schorr:
Right. Well, so one last thing before we let you go, Dr. Shah. And then, Dr. Anderson, we'll just go a couple more minutes. Dr. Shah, you're in San Francisco where those of us who watch the news who are not there know it's cordoned off, if you will. So what is life like there, and for cancer patients? What is life like there for the people, just what's the mood there now, if you will?

Dr. Shah:
Yeah, and I think as you would expect, it's ghost townish in the streets where usually it's populated with all our tourists, et cetera. And interestingly, San Francisco, it's not like there were so many cases there like there were in the Washington state area, it's more that we saw what was coming, and so we preemptively have this whole shutdown happening and also have the shelter in place. And so right now it's eerie to be there, but it also has caused people to be very innovative again, with things like communicating over Zoom.

All of our employees, if they're not clinically essential, are communicating by this mechanism that we're doing now. And a lot of people have really gotten good about being responsive electronically, et cetera. We are trying to send love to all our patients and all our friends and family members remotely for now. But I think it'll be the birth of some innovation.

Andrew Schorr:
I think so. I wanted to make just one comment, and then we'll let you go, and Dr. Anderson will stay with us just another couple of minutes. In Spain, and we did an interview with our friends in Spain earlier, maybe you've seen that they go out on their balconies. In Italy, they sing, in Spain I think at 8 o'clock at night, they go applaud the healthcare providers. So I'm doing that for you. You guys are angels, and we know that this is a stressful time for you and your colleagues. Thank you for your dedication, Dr. Nina Shah. We're going to let you ring off and let you…

Dr. Shah:
Thanks.

Andrew Schorr:
...take care patients. Dr. Anderson is going to stay with us for just another couple of minutes for some other questions. Thank you so much for being with us.

Dr. Shah:
Bye. Thanks for having me.

Andrew Schorr:
Thank you. Thank you so much. Okay, Dr. Anderson, I save you for as we wrap up. So what do you want to leave people with? Myeloma patient,. I know some of it is the same as we tell the general population, but again we have often myeloma patients who are older, not always, higher risk 70, 80. And we have people on immunosuppressive treatments that they're on some schedule for. And the disease can be immunosuppressive anyway.

Dr. Anderson:
Mm-hmm.

Andrew Schorr:
Not good.

Dr. Anderson:
It's a triple whammy. Yeah.

Andrew Schorr:
Yeah, it's a big whammy. What do you want to tell people to at least give us hope that we can get through this together?

Dr. Anderson:
Yeah, so the main message would be, don't panic, but be cautious and take precautions, and you should be fine. By staying away from crowds, by self-isolating, by social distancing, hand hygiene, stop touching the face. All these things come together. I think that's going to be your key to staying healthy and living through this. And patients that are exposed and get the disease, we don't yet know how impactful that will be and what the true implications are yet for our patients. But certainly we do worry that the patients that get exposed are going to have a rougher time than the average population. And so just trying to avoid, it's going to be the best policy.

Andrew Schorr:
I was going to say one other thing is, let your community help you. And I mean the broad community, your neighbors. If somebody says, "Mrs. Jones, Mrs. Rodriguez, I'll go shopping for you." Let them.

Dr. Anderson:
Yeah, as long as they're not having symptoms, then let them.

Andrew Schorr:
Yeah.

Dr. Anderson:
And yeah, younger family members that are able to go to the grocery store, so you don't have to go in there and touch everything. That's even better as well.

Andrew Schorr:
Right. And some of the supermarkets are having special times for older people as well, so check that out. So, folks, a couple of things I wanted to mention for everybody. So, Dr. Anderson, you probably know Dr. Frits van Rhee at the University of Arkansas. So we had already scheduled a myeloma town hall meeting with him, and we have another myeloma specialist from Charlotte who's going to be on, so that's in April, folks. And that'll be a three-hour event but all online just like this. And we'll discuss soup to nuts, myeloma, first of all, which you have ongoing, right? We want you to be cured, but if we can't cure it, you're living with it, and we'll get past hopefully this infection risk. Layered on top of that. We're going to discuss all of that.

You can sign up for it. It's all free on patientpower.info. Look under upcoming events. That's April 18th, Saturday, April 18th Dr. Anderson has been with us a number of times. We'll let you go. Larry, thank you for the work you do at UT Southwestern in Dallas and your dedication to patients. I'm going to applaud you too. And we'll let you go and thank you so much for being with us, Dr. Larry Anderson.

Dr. Anderson:
Pleasure. Thanks for having me.

Andrew Schorr:
Okay, we'll let you go there. And you can click off there. All right, folks, so be sure to send us questions, [email protected] Send them anytime.

I'm a leukemia patient and have another blood cancer as well, so I'm in this right with you. We will get through it. Jill, thank you. Thank you for thanking us. Thanks for our wonderful Patient Power team. Look for information about a program next week. And then remember to sign up for that big event, virtually for April 18th that'll have some of our experts. Including from the University of Arkansas Medical Center, which has been a pioneer in multiple myeloma. I'm Andrew Schorr, remember, knowledge can be the 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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