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Dr. Vincent Rajkumar Answers on Myeloma Treatment During COVID-19

Dr. Vincent Rajkumar Answers on Myeloma Treatment During COVID-19
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Published on March 30, 2020

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Vincent Rajkumar, MD - Professor of Medicine and Chair of the Myeloma Amyloidosis Dysproteinemia Group at the Mayo Clinic, Rochester, MN., answers questions on a recent Twitter thread, related to myeloma treatment in light of the COVID-19 pandemic. 

Clearly the best person to help is your own doctor. I’ll try and answer— at least give a general guidance based on risk/benefit judgment. @VincentRK

 

Question: One of the most common questions we are getting is on Transplant

Answer: As I previously noted We recommend DELAYING the transplant process (including collection, & storage) for all newly diagnosed patients until the corona epidemic is over. If myeloma patients are already in the process of collecting stem cells, go ahead and collect, but delay the transplant especially for standard risk patients.
If any insurance company gives problems let us know. We need to document this.

Question: Should we stop Revlimid maintenance to lower risk of COVID?

Answer: Don't stop maintenance. Relapse of myeloma is riskier than Revlimid

Question: Will delaying collection & giving multiple cycles of VRd compromise the ability to collect cells later?

Answer: Risk is low with plerixafor. Risk of exposing patients to COVID during collection is far more than risk of not being able to collect. Delay collection for now.

Question: Best frontline treatment in these times?

Answer: VRd x 8. Len maintenance (for most patients). If high risk Len plus bortezomib (lower dose than initial VRd). @NorthTxMSG @mtmdphd

Question: Response is slow and doctors don’t want to go to transplant because of COVID. What to do?

Answer: Slow and steady wins the race. A slow response does not mean that the disease is bad. Risk of transplant is high. So continue on treatment that’s working.

Question: Will IVIG help against COVID

Answer: No

Question: If I get COVID should I hold Revlimid (or other myeloma therapy).

Answer: My colleagues and I feel we have no data but that a short interruption till one recovers from COVID seems prudent. No data.

Question: Do I need monthly Zometa?

Answer: No. please let’s do Zometa every 3-4 months. I was not convinced of the need for monthly before. And I’m even more convinced of that now in light of the COVID situation.

 

For more, follow on Twitter @VincentRK

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