Published on July 31, 2020
What Have Experts Learned About How COVID-19 Affects Myeloma Patients?
Dr. Joshua Richter, Assistant Professor of Medicine, Division of Hematology and Medical Oncology, Tisch Cancer Institute, Mount Sinai School of Medicine joins Patient Power co-founder, Andrew Schorr to share what doctors have learned about treating multiple myeloma patients with COVID-19 in New York. Myeloma patients are considered high risk for more serious reactions to Coronavirus and should follow specific guidelines to reduce exposure. Watch to hear the full report.
Transcript | Multiple Myeloma and COVID-19: What Experts Have Learned
Hello and welcome to Patient Power, I'm Andrew Schorr in Southern California. In New York, there's Dr. Joshua Richter who joins us from Mount Sinai, a renowned myeloma specialist, and certainly people with myeloma, whether they're in New York or California or wherever, worry during this COVID-19 pandemic. Are myeloma patients more at risk, particularly of complications should they develop the COVID-19?
So Dr. Richter, you're in New York where you guys have really been through it. Fortunately, it's gone down. You have experience with your myeloma patients, some of whom must have been diagnosed with COVID. What are you hearing? What do you know personally?
Sure. Obviously, you can't talk about anything nowadays without talking about COVID. It greatly impacts everything we do, including care for our myeloma patients. Unfortunately, we've seen a higher risk of what we call morbidity, which is getting sick from it, and even mortality, dying from COVID, in patients with myeloma.
We've done extensive studies actually here at Mount Sinai and along with the other major myeloma centers in the city and published our experience, and there's a few things that we're starting to see. One of them is that the people who seem to get the sickest aren't necessarily the people who have had 10 lines of therapy and are more towards the end of their journey. It could actually be some of the people who are a little bit early on.
This actually comes from the fact that COVID seems to have three main phases: a viremic phase, where the virus comes in, replicates, and causes trouble; that leads to an inflammatory phase, where you get high inflammatory markers and can get high fevers and quite sick; and that chronic inflammation can lead to something called fibrosis, where the lungs can get kind of like scar tissue. People who are a little bit earlier on in their diagnosis may have a more robust inflammatory response because their inflammatory mechanisms may be more intact because they haven't had as much chemotherapy.
In fact, we've seen this in a large number of patients, and the corollaries actually are that this inflammation is something we call cytokine release syndrome (CRS), where chemicals in the body called cytokines ramp up this response. We see a very similar pattern in people receiving CAR T-cell therapy. So, we've actually adopted a lot of our techniques to not only measure cytokines in real time in the lab so that we can use this lab technique for CAR Ts in real time for COVID patients, but we're using some of the same therapies to treat CRS in CAR T. We're using that to treat a CRS phenomenon in our myeloma patients, along with new data showing that some of the drugs we use for myeloma, drugs like dexamethasone (Decadron) and maybe even drugs like Selinexor (Xpovio), may have an anti-COVID effect. So, we're starting to see more and more evidence of how to actually treat and control the symptoms.
Okay. The question that myeloma patients are hanging on though is, “Because I have myeloma, am I at higher risk of bad things from COVID?” And what's your experience?
My experience is likely yes. We don't have the complete picture of everything, but now that we're testing everybody, we're really starting to get a better picture because many people may be asymptomatic. But I would say as a default, yes, people with myeloma are at higher risks.
So, what I would say as a suggestion is as things start to loosen up, still have the reservation, still practice social distancing, hand washing, masks. This has been a long, arduous task for everyone. Please don't immediately go out and change the way you've been over the last couple months. Continue to practice social distancing and awareness to make sure you prevent transmission and spreading of COVID.
Okay, and just to understand something you said earlier, it's not necessarily the older, frailest patient who has the worst go with COVID, it could be a younger patient.
Absolutely. Because one of the critical points in the disease is this inflammation, people who have had many immune-based therapies, and all our therapies in myeloma suppress the immune system at some level, people who have many therapies may not get that big inflammatory response. And it turns out that people who may be a little younger and even have more of an intact immune system may get sicker. So, exactly to your point, even if you're younger and in remission, that doesn't mean that you should feel free to go out everywhere. You still need to be concerned for problems from COVID.
Okay. One last question. You mentioned dexamethasone. There was some research that said that could help, my understanding is, with people who really were on oxygen therapy. But myeloma patients, many of them have dexamethasone. They say, "Whoa, I'm going to pop some pills or something, and this is going to protect me." So, maybe you could just put it in perspective for people. Is there any myeloma medicine they're on or they could take more of that would be like a force-shield, somehow protect them?
No. I wish that were the case. In fact, some institutions recommend taking your temperature prior to taking your dexamethasone with your therapy because dexamethasone may mask a fever. So, once you take it, you may not even know if you're starting to develop these types of symptoms. But overall, dexamethasone is not really a preventative measure, but when people get into that inflammatory phase, it's the number one anti-inflammatory. We talk about drugs like Advil being an NSAID, a nonsteroidal anti-inflammatory, because steroids are the big anti-inflammatory. So, it's not a prevent-all. It's not a force field. I wish it were, but in people who do get sick, please don't take these medicines to help prevent without first consulting with your care team.
Okay. Well, thank you for all you do for all of us worldwide but also your work in New York at Mount Sinai has certainly been a leader in trying to get answers as we continue to get information and data understanding how COVID affects different populations, different ages. And thanks for sharing your knowledge about myeloma. Dr. Joshua Richter, joining us from Mount Sinai in New York, thank you for being with us. I'm Andrew Schorr. Remember, knowledge, and now safety precautions, 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.